COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX64170160 
R  A644.T7  N37  1 91 4    The  effect  of  tuberc 


437 
191 


<FECT  OF   TUBERCULOSIS 

liNonTUTIONS  ON  THE  VALUE 

AND   DESIRABILITY   OF 

SURROUNDING 

PROPERTY 


By 


THE,  NATIONAL  ASSOCIATION   FORTHE   STUDY 
AND  PREVENTION  OF  TUBERCULOSIS 


"The  trouble  with  this  matter  is  that 
antiquated  ideas  and  unfounded  impressions 
still  prevail  among  those  who  have  not  made 
a  study  of  the  subject." 

Hamilton   W.  Mabie 


105  East  22d  Street 
NEW  YORK 
1914 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/effectoftuberculOOnati 


£4 


TABLE  OF  CONTENTS 

CHAPTER  PAGE 

INTRODUCTION 5 

I.     A  REVIEW  OP  PREVIOUS  STUDIES 7 


Effect  of  Any  Institution  Upon  Property  Values  (7) — Change 
in  Value  of  Property  (8) — Attitude  of  the  Community  (8) — 
Some  Individual  Instances  (9) — A  Little  Knowledge  Dan- 
gerous (9) — Judgment  in  Selecting  Sites  (9) — Where  the  Danger 
Lies  (10)— A  Later  Study  (10). 

II.     A  QUESTIONNAIRE   STUDY   OF  EIGHTY-FOUR  INSTI- 
TUTIONS      12 

Length  of  Operation  (12) — Density  of  Neighboring  Population 
(13) — Character  of  District  (13) — Value  of  Institution  Property 
(13) — Increase  of  Surrounding  Property  (13) — Beneficial  Effect 
of  Institutions  (14) — An  Aid  to  Health  (14) — Increase  in  Prop- 
erty Values  (14) — No  Danger  of  Infection  Spreading  (16) — 
Opposition  Does  Not  Last  (18) — Hospitals  Benefit  Health  of 
Neighbors  (19) — An  Exception  (19). 

III.  ASSESSED  PROPERTY  VALUES  AROUND  FIVE  INSTI- 

TUTIONS      21 

Hospital  Within  Limits  of  Large  City  (21) — Hospital  Within 
City  (24)— Hospital  Within  Half  Mile  of  City  (25)— Hospital 
Near  Village  (27) — Hospital  Located  in  Farming  District  (28). 

IV.  TYPICAL   LAWS    AND    ORDINANCES    COVERING   THE 

APPROVAL  AND  RESTRICTION  OF  HOSPITAL  SITES     30 

New  York  (30) — New  Jersey  (31) — Restrictive  Ordinances  (32). 

V.     SOME  OPINIONS  OF  VALUE 34 

Dr.  E.  L.  Trudeau  (34)— Hamilton  W.  Mabie  (35)— Dr.  E. 
M.  Mason  (35) — California  Association  (36) — Opinions  of  Life 
Insurance  Companies  (36) — San  Francisco  Health  Board  (38) — 
New  York  State  Health  Department  (39). 

VI.     COURT  DECISIONS 41 

Boston,  Mass.  (41)— Asheville,  N.  C.  (41)— Orange,  N.  J.  (41) 
—Richmond,  Va.  (42)— Seattle,  Wash.  (43)— Redlands,  Cal. 
(43)— Houston,  Tex.  (44). 


VII.     SUMMARY  AND  CONCLUSIONS 46 

Hospital  not  a  Menace  to  Health  (46) — Hospital  not  Detri- 
mental to  Property  (47) — Initial  Opposition  Seldom  Lasts  (48) 
—Some  Minor  Objections  to  Sanatoria  Refuted  (49) — Hos- 
pitals a  Benefit  to  the  Community  (50) — Some  General  Sugges- 
tions as  to  Location  (51). 

APPENDIX 54 

Tables  showing  change  in  assessed  valuation  of  surrounding 
property  of  five  hospitals. 

MAPS facing  pages  26-27 

Showing  property  around  Seton  Hospital  and  Montefiore  Sana- 
torium. 


INTRODUCTION 

The  question  of  the  effect  of  institutions  for  the  treatment  of 
tuberculosis  upon  the  value  and  desirability  of  surrounding 
property  has  been  and  still  is  raised  with  almost  every  attempt 
to  locate  a  hospital,  sanatorium,  or  dispensary.  Nearly  all 
such  attempts  call  forth  the  same  objections  which  are  met 
with  varying  effectiveness  depending  upon  the  information 
available.  The  National  Association  for  the  Study  and  Pre- 
vention of  Tuberculosis  has  prepared  this  report,  in  order  that 
the  recital  of  experience  and  the  opinions  contained  in  it  may 
prevent  needless  discussion,  and  facilitate  the  locating  of  future 
institutions  by  giving  all  parties  concerned  access  to  full  and 
authoritative  information  on  the  subject. 

The  study  is  divided  into  eight  parts  as  follows: 

I.  A  review  of  former  investigations  of  this  character, 
including  those  by  William  H.  Baldwin  and  Philip  P.  Jacobs. 

II.  Information  obtained  from  a  questionnaire  study  of 
eighty-four  hospitals  and  sanatoria  in  all  sections  of  the  United 
States  with  regard  to  the  change  in  surrounding  property  values ; 
the  effect  of  these  institutions  on  the  health  of  the  neighbors; 
the  original  reasons  for  opposition  and  the  present  feeling; 
some  material  benefits  of  an  institution  to  the  neighborhood; 
and  many  pertinent  comments  by  superintendents  on  all  phases 
of  the  question. 

III.  Facts  obtained  in  a  first  hand  investigation  of  five  in- 
stitutions in  different  localities  and  of  different  types,  to  show 
the  rise  or  fall  of  assessed  valuation  of  surrounding  property; 
the  increase  of  property  values  indicated  by  known  sales;  the 
expressed  feeling  of  property  owners;  and  the  feeling  of  the 
general  public. 

IV.  A  digest  of  several  typical  laws  regulating  the  approval 
of  sites,  and  some  restrictive  ordinances. 

5 


V.  Some  opinions  of  eminent  men,  boards  of  health,  and 
insurance  companies. 

VI.  Court  decisions  relating  to  the  location  of  hospitals, 
sanatoria  and  dispensaries,  including  the  possibility  of  their 
being  a  menace  to  public  health,  or  a  nuisance. 

VII.  Summary  and  Conclusions. 

VIII.  Appendix,  with  assessment  tables  referring  to  hospitals 
in  Chapter  II. 


CHAPTER   I 


A  Review  of  Previous  Studies 

The  first  comprehensive  investigation  of  the  relation  of 
tuberculosis  hospitals  and  sanatoria  to  surrounding  property 
was  conducted  by  the  questionnaire  method,  by  William  H. 
Baldwin,  of  Washington,  D.  C.  His  report  was  read  before 
the  Second  Annual  Meeting  (1906)  of  the  National  Association 
for  the  Study  and  Prevention  of  Tuberculosis,  at  Washington, 
D.  C.  Liberal  quotations  presenting  the  most  interesting  facts 
and  conclusions  from  the  fund  of  valuable  information  col- 
lected by  Mr.  Baldwin,  are  presented  here  because  the  original 
report  is  not  generally  available : 

Effect  of  Any  Institution  Upon  Property  Values 

"  In  studying  this  effect  two  elements  are  to  be  distinguished,  the  influence 
of  the  building  and  improvements  as  such,  and  the  purpose  for  which  these 
are  used. 

"  It  may  be  said  that  as  a  rule  the  erection  of  any  building  not  in  itself 
objectionable,  by  taking  up  a  certain  amount  of  land  and  so  decreasing 
the  remainder  available,  while  increasing  the  purposes  for  which  it  may  be  used, 
enhances  the  value  of  the  surrounding  land  and  so  is  an  advantage  to  it. 
The  value  of  any  piece  of  land  is  determined  by  many  influences,  depending 
upon  the  various  uses  to  which  it  may  be  put.  Unoccupied  land  is  likely 
to  be  used  first  for  grazing  or  farming,  then,  as  population  increases,  for  resi- 
dences, and  later  for  business  purposes,  manufacturing  or  trade,  or  both. 
So  far  as  the  value  of  surrounding  property  is  concerned,  that  building  is 
most  desirable  which  best  fulfills  the  general  purpose  for  which  land  in  the 
vicinity  is  used — a  good  farm-house  in  the  country,  or  a  fine  residence  on  an 
improved  street,  or  a  large  store  in  the  business  section. 

"A  building,  no  matter  what  its  use,  which  is  discordant  in  any  way 
lessens  the  desirability  of  contiguous  property  and  so  detracts  from  its  value, 
as  a  store  in  a  residence  street.  Generally  speaking,  any  large  institution 
of  which  the  inmates  are  not  united  by  association  or  community  of  interest 
with  the  people  of  a  closely  settled  neighborhood,  in  which  it  is  placed,  is  a 
detriment  to  property  about  it.  Beauty  of  buildings  or  of  grounds  may 
decrease  this  disadvantage  in  spite  of  the  lack  of  connection  between  it  and 
its  environment. 

"  Suburban  or  country  property  is  not  so  much  affected  by  such  an  insti- 
tution because  initial  values  are  less,  and  may  be  so  low  that  its  presence 
will  cause  values  to  rise.  An  increase  in  population,  other  things  being 
equal,  helps  values,  and  the  institution  may  be  relatively  large  enough  to 


have  this  effect.  Such  improvement  may  be  limited  and  should  be  compared 
with  what  might  have  taken  place  or  the  extent  to  which  it  might  hereafter 
be  likely  to  go  if  there  had  been  no  such  institution. 

"  Hospitals  of  any  kind  would  be  objectionable  to  some  people,  partly 
because  of  the  reason  given  above  and  partly  because  the  proximity  of  suffering 
or  sickness  is  in  itself  distasteful.  A  detention  hospital  raises  this  opposition 
to  the  superlative  degree,  and  prospective  neighbors  have  been  known  to 
fight  off  such  a  necessary  refuge  for  the  unfortunates  requiring  treatment 
somewhere  with  all  the  fervor  of  a  holy  war. 

"  This  leads  us  to  the  element  in  the  problem  of  the  effect  of  the  institu- 
tion on  the  value  of  surrounding  property — the  knowledge  that  it  is  for  tuber- 
culous patients.  In  itself,  it  must  be  objectionable,  for  tuberculosis  is  now 
known  to  be  communicable  rather  than  hereditary,  and  those  who  know  no 
more  are  likely  to  fear  and  avoid  it.  Fuller  knowledge  dispels  the  fear  and 
shows  that  under  the  training  of  a  well-conducted  sanatorium,  there  is  less 
danger  of  infection  from  a  hundred  patients  than  from,  two  uninstructed 
consumptives  going  at  will  about  the  streets  and  disposing  of  their  sputum 
in  the  way  most  convenient  for  themselves.  We  cannot  overcome  all  the 
disadvantages  of  an  institution,  as  such,  but  we  can  and  should  be  sure  that 
it  is  not  in  the  slightest  degree  a  menace  to  the  health  of  those  who  live  near 
it.  This  danger  being  therefore  imaginary  rather  than  real,  there  remains 
the  interference  with  the  serenity  of  people  in  the  neighborhood  who  come 
in  contact  with  men  and  women  whose  appearance  often  discloses  the  struggle 
for  life  they  are  making,  in  which  some  are  not  winning. 

Change  in  Value  of  Property 

"  In  order  to  learn  the  facts  concerning  sanatoria,  already  established,  an 
inquiry  was  addressed  to  seventy-seven  of  the  largest  of  such  institutions 
throughout  the  United  States  and  in  Canada. 

"Although  the  question  as  to  any  change  in  the  value  of  the  land  owned 
by  the  institution,  measured  either  by  its  valuation  for  taxation  when  ac- 
quired and  now,  or  in  other  ways,  bears  directly  on  the  subject  and  was  plainly 
asked,  it  was  not  answered  in  thirty  of  the  responses,  and  four  replied  that 
the  land  was  not  valued  for  taxation.  The  other  twenty-five  reported  as 
follows:  3  increased;  3  much  increased;  10  doubled  in  value  or  more;  9  no 
change. 

"  In  no  case  is  it  stated  that  the  land  on  which  the  institution  is  situated 
has  decreased  in  value,  and  as  its  worth  depends  largely  upon  the  value  of 
surrounding  property,  there  is  nothing  in  this  to  indicate  an  unfavorable 
effect  of  the  sanatorium. 

"  Coming  directly  to  the  difference  in  the  character  of  value  of  adjacent 
property  since  the  founding  of  the  sanatorium,  an  answer  more  or  less  definite 
has  been  obtained  as  to  each. 

"  In  58  per  cent,  of  the  instances,  there  has  been  an  increase  in  the  value 
of  the  land  adjacent,  accompanied  in  17  per  cent,  by  a  change  for  the  better 
in  the  purposes  for  which  it  is  used;  in  35  per  cent.,  there  has  been  no  change, 
and  in  7  per  cent.,  a  more  or  less  marked  depreciation  in  land  immediately 
adjoining  is  admitted.  In  one  instance,  this  effect  is  for  a  distance  of  400  to 
800  feet,  in  another  up  to  1,500,  while  in  the  other  two  cases,  the  opinion  is 
given  that  the  presence  of  the  sanatorium  has  prevented  or  would  prevent 
sales. 

Attitude  of  the  Community 

"  Connected  with  the  foregoing,  both  as  cause  and  effect,  is  the  attitude 
of  the  community  toward  the  institution.  In  one  case  it  is  not  stated,  in 
thirty-seven  it  is  said  that  there  has  been  no  opposition  at  any  time,  in  two 
that  there  was  once  vigorous  opposition,  in  five  that  there  is  some  objection 
still,  and  in  fourteen  that  there  was  once  opposition,  which  has  since  disap- 
peared." 


Some   Individual  Instances* 

"  Some  reference  to  individual  instances  may  be  instructive.  The  Cullis 
Consumptives'  Home  for  Advanced  Cases  at  New  Dorchester,  a  part  of 
Boston,  Massachusetts,  was  removed  to  its  present  location  in  1871.  There 
was  no  opposition  then,  but  there  was  considerable  when  a  permit  was  asked 
for  the  new  building  in  1896,  due,  probably,  to  the  discovery  meantime  that 
the  disease  is  communicable.  A  careful  examination  showed  that  there  was 
no  danger  and  proved  that  the  death  rate  from  tuberculosis  in  that  ward  was 
the  lowest  in  the  city.  Further  experience  has  made  warm  friends  of  nearly 
all  those  who  were  in  opposition  eight  years  ago.  The  assessed  value  of 
surrounding  land  is  about  five  times  as  great  as  it  was  in  1870. 

"  The  Brooklyn  Home  for  Consumptives  was  established  in  1881  and  has 
been  removed  to  another  location  since.  There  has  been  no  objection  to  it 
in  either  place.  No  employee,  though  some  of  them  have  served  eighteen 
years,  has  ever  contracted  the  disease.  The  institution  is  well  kept  and  one 
of  the  board  of  health  officers  has  expressed  the  wish  that  there  were  a  hundred 
more  like  it. 

"  St.  Joseph's  Hospital  for  Consumptives,  in  New  York,  started  in  1882, 
has  apparently  had  no  unfavorable  effect  upon  values,  perhaps  because  it 
occupies  an  entire  block  and  is  surrounded  by  a  garden  which  gives  light  and 
air  to  the  apartment  houses  which  have  since  been  built  up  around  it.  There 
has  never  been  any  opposition  to  it,  and  values  of  adjacent  property  have 
increased  from  one-fourth  to  one-half. 

"  These  three  are  fair  examples  of  the  influence  of  a  well-conducted  sana- 
torium in  the  city." 

A  Little  Knowledge  Dangerous 

"A  study  of  these  various  instances  indicates  that  twenty  years  ago  there 
was  indifference  to  the  establishment  in  the  neighborhood  of  an  institution 
for  the  treatment  of  tuberculosis.  A  partial  knowledge  of  the  nature  of  the 
disease  has  produced  a  hyper-sensitiveness  in  regard  to  it  and  developed 
opposition  which  a  fuller  experience  removes  in  time.  In  some  cases  this 
opposition  is  due  to  prejudice  rather  than  to  any  feeling  of  danger  or  the 
possibility  of  any  considerable  decrease  in  the  commercial  value  of  property. 

"  So  in  the  establishment  of  a  sanatorium,  it  sometimes  seems  that  the 
real  obstacle  is  the  prejudice,  the  groundless  fear,  the  unreasonable  and  un- 
reasoning opposition  of  the  people,  in  comparison  with  which  the  raising  of 
funds,  the  removal  of  rocks,  and  the  construction  of  buildings  are  trifles. 
Where  such  antagonism  exists,  whether  just  or  not,  it  demands  consideration 
and  any  needless  interference  with  values  should  be  avoided.  Experience 
has  proved  that  there  is  absolutely  no  danger  from  a  well-conducted  sanator- 
ium, and  that  there  is  no  valid  reason  for  fear  in  regard  to  it.  Too  much 
emphasis  cannot  be  laid  upon  this  point;  but  it  is  easier  to  explain  this  to 
the  few  people  in  the  suburbs  or  in  the  country  than  to  the  many  in  a  more 
thickly  populated  section.  Whatever  damage  there  is  will  be  less  in  the  case 
of  property  not  already  very  valuable  than  in  that  of  residential  streets  or 
fine  suburban  homes." 

In  discussing  this  paper  at  the  time  it  was  read,  Homer  Folks,  of  New 
York,  said: 

Judgment  in  Selecting  Sites 

"  The  chairman,  Mr.  Baldwin,  did  not  refer  to  our  experience  in  establish- 
ing a  tuberculosis  dispensary  in  the  Borough  of  Brooklyn.  The  health 
department  of  the  city  endeavored  to  locate  the  first  and  only  tuberculosis 
dispensary  in  the  Borough  of  Brooklyn.  It  selected  a  building  and  the 
residents  of  the  neighborhood  protested  vigorously  and  finally  brought  a  suit 
to  enjoin  the  health  department  from  establishing  a  dispensary  at  this  place. 

*  These  opinions  were  given  in  1906,  it  should  be  noted. 


Although  those  who  were  interested  in  the  establishment  of  the  dispensary 
felt  no  special  concern  over  the  suit,  feeling  sure  that  no  court  of  high  degree 
would  decide  that  such  a  dispensary  would  be  dangerous  to  the  health  of  the 
residents,  they  were  disappointed.  Excellent  medical  authorities  submitted 
affidavits  in  evidence  showing  that  such  a  dispensary  would  be  of  absolutely 
no  danger  to  the  community,  but  in  what  I  think  I  may  call  a  most  extra- 
ordinary decision,  it  was  held  that  the  evidence  of  the  physicians  was  not  at 
all  conclusive  and  that  there  could  be  no  doubt  that  such  a  dispensary  would 
be  very  dangerous  indeed  to  the  health  of  the  neighborhood,  and  the  depart- 
ment was  enjoined.  That  still  stands  and  there  is  no  dispensary  there 
today  (1906)."  * 

Where  the  Danger  Lies 

Continuing  the  discussion,  John  H.  Lowman,  M.D.,  of  Cleveland,  President 
of  the  National  Association  in  1914,  remarked: 

"A  well-conducted  sanatorium  is  almost  absolutely  free  from  danger  and 
it  is  in  no  degree  a  menace  to  the  public. 

"  Turban  of  Davos  (Switzerland)  states  that  there  has  never  been  but  one 
case  of  tuberculosis  that  has  developed  among  his  employees — that  of  a  maid 
who  washed  the  linen  of  the  patients.  Although  3,000  patients  have  been 
treated  in  his  institution,  this  is  the  only  case  in  which  there  has  been  any 
suspicion  of  contagion.  Joel  of  Goerbersdorf  (Germany)  has  failed  to  find 
a  single  case  of  infection  in  the  institutions  there,  although  13,000  patients 
have  been  treated  in  them. 

"  Cultures  have  been  repeatedly  made  from  the  walls  of  sanatoria  in  the 
wards  and  rooms  where  patients  stay,  and  in  no  case  have  the  bacilli  been 
found.  It  would  seem  that  a  sanatorium  is  the  place  most  free  from  dangers 
of  infection. 

"According  to  Dr.  Coate's  (Manchester)  experiments,  60  per  cent,  of  the 
houses  in  which  consumptives  live  are  infected.  Thus  it  is  the  uninformed 
patient  who  is  a  danger  to  the  community  and  not  the  supervised  patient 
in  a  sanatorium.  Were  these  facts  known  and  understood  by  the  public  the 
fear  of  contagion,  which  is  the  origin  of  the  opposition  to  the  sanatorium, 
would  disappear  and  the  present  difficulties  would  cease." 

A  Later  Study 

In  1909,  Philip  P.  Jacobs,  then  Assistant  Secretary  of  the  Nat- 
ional Association  for  the  Study  and  Prevention  of  Tuberculosis, 
conducted  by  the  questionnaire  method  an  investigation  of 
the  effects  of  37  institutions  located  in  22  different  states  in  all 
parts  of  the  country.  The  findings  of  this  investigation  were 
tabulated  and  given  to  the  press  of  the  country.  Some  quo- 
tations  are  significant : 

"According  to  information  received  from  sanatorium  superintendents, 
real  estate  dealers,  and  various  disinterested  parties,  76.5  per  cent,  of  these 
tuberculosis  sanatoria  have  had  a  favorable  influence  upon  surrounding  prop- 
erty, and  have  been  a  benefit  to  the  community  in  which  they  were  located. 
In  the  case  of  23,  or  62.2  per  cent,  of  the  institutions,  the  presence  of  the 
sanatorium  helped  to  increase  the  assessed  valuation  of  surrounding  property. 
In  only  one  instance  has  property  decreased  in  value,  and  there  it  was  due  to 
ignorance  of  the  facts.  In  22  out  of  the  37  cases,  the  presence  of  a  sanatorium 
has  even  been  helpful  in  the  recent  sale  of  land,  and  in  only  four  places  has 

*  There  are  now  several  in  other  sections  of  the  city,  and  in  this  same  general  neighbor- 
hood. 

10 


any  detrimental  effect  on  sales  been  shown.  In  51.3  per  cent,  of  the  cases, 
residents  have  been  attracted  to  the  community  by  the  sanatorium,  and  in 
only  three  localities  have  residents  been  repelled.  Some  examples  show  the 
increase  in  the  value  of  surrounding  property.  In  the  vicinity  of  a  sanatorium 
in  Portland,  Ore.,  land  has  more  than  doubled  in  value  in  three  years,  and 
is  in  demand  close  to  the  sanatorium.  At  Aiken,  S.  C,  property  in  the 
neighborhood  of  the  local  sanatorium  has  increased  400  per  cent,  since  the 
institution  was  built.  At  Hebron,  Me.,  surrounding  property  has  increased 
20  per  cent,  as  a  direct  result  of  the  presence  of  a  tuberculosis  sanatorium. 
A  similar  effect  upon  land  values  has  taken  place  in  other  towns,  such  as 
Luzerne,  Pa.,  Liberty,  N.  Y.,  Saranac  Lake,  N.  Y.,  Pittsford,  Vt.,  Mt. 
Vernon,  Mo.,  and  Silver  City,  N.  Mex.  At  Asheville,  N.  C,  vacant  lots 
near  one  of  the  sanatoria  in  that  city  sell  at  four  times  their  price  in  1900  and 
those  farther  from  the  institution  but  nearer  the  city  are  less  valuable. 
Not  a  single  instance  was  reported  where  the  presence  of  a  tuberculosis  sana- 
torium, camp  or  dispensary  in  a  large  city  has  had  a  detrimental  eflect  on 
the  value  of  surrounding  property." 


11 


CHAPTER  II 


A  Questionnaire  Study  of  Eighty-four 
Institutions 

Dining  1913,  the  office  of  the  National  Association  for  the 
Study  and  Prevention  of  Tuberculosis  obtained  by  the  ques- 
tionnaire method  a  large  fund  of  information  relating  to  the  effect 
of  tuberculosis  institutions  in  all  sections  of  the  United  States 
on  the  value  and  desirability  of  surrounding  property.  The 
questions,  which  were  directed  to  the  superintendents  of  in- 
stitutions, were  answered  in  a  way  that  gives  assurance  of 
their  reliability,  and  in  most  instances  were  complete.  Eighty- 
four  replied  to  some  or  all  of  the  questions.  The  facts  thus 
obtained  support  those  collected  in  the  earlier  investigations. 

A  review  of  this  data  shows  that  of  the  84  institutions,  2 
were  federal  sanatoria,  18  were  state  sanatoria,  10  were  county 
or  municipal  hospitals,  32  private  charitable  sanatoria  or  hos- 
pitals, and  22  private  commercial  hospitals,  operated  for  profit. 
The  institutions  include  tuberculosis  sanatoria  and  hospitals 
of  all  sizes  and  kinds,  distributed  geographically  in  almost 
every  section  of  the  country. 


Length  of  Operation 

With  regard  to  the  length  of  operation,  fourteen  of  the  insti- 
tutions have  been  running  for  ten  years,  thirty-one  from  five 
to  ten  years,  twenty  from  three  to  five  years,  seventeen  from 
one  to  three  years  and  only  two  less  than  one  year.  Since 
seventy-five  per  cent,  of  these  institutions  have  been  in  opera- 
tion five  years  or  more,  their  influence  has  had  time  to  become 
well  defined. 

12 


Density  of  Neighboring  Population 

With  regard  to  the  density  of  population  in  the  neighborhoods 
where  the  institutions  are  located,  fourteen  of  the  eighty-four 
are  located  in  districts  which  may  be  called  "  thickly"  settled, 
while  seventy  are  in  sections  that  may  be  designated  as  "  sparse- 
ly "  settled.  These  facts  were  checked  for  accuracy  by  replies 
to  a  question  which  asked  the  superintendent  to  give  the  distance 
from  the  sanatorium  of  the  nearest  dwelling. 

Character  of  District 

As  to  the  character  of  the  districts  in  which  the  various  in- 
stitutions are  located,  fifty-seven  are  situated  in  farming  districts 
and  twenty-seven  are  situated  in  residential  districts,  while  so 
far  as  learned  none  of  the  eighty-four  are  in  wholly  industrial 
districts. 

Value  of  Institution  Property 

The  value  of  the  sanatorium  property  when  the  institutions 
were  opened  is  worthy  of  consideration.  While  exact  figures 
are  not  given  in  all  cases,  the  designations  are  sufficiently 
accurate  for  this  purpose.  The  value  of  the  sites  at  the  time 
of  the  opening  of  the  sanatoria  was  in  five  cases  less  than  $10 
per  acre;  in  twenty-eight,  it  was  from  $10  to  $100  per  acre; 
in  sixteen,  it  was  from  $100  to  $300  per  acre;  in  four,  it  was 
from  $300  to  $500  per  acre;  in  three,  it  was  from  $500  to  $1,000 
per  acre;  in  five,  it  was  from  $1,000  to  $3,000  per  acre;  in  one, 
it  was  over  $3,000  per  acre;  and  in  twenty-two  the  value  was 
not  specified.  The  information  previously  given  as  to  the  char- 
acter of  the  districts  is  thus  supported  by  these  facts,  that  the 
great  proportion  of  the  sanatoria  were  erected  on  property 
which  did  not  cost  more  than  $300  per  acre. 

Increase  of  Surrounding  Property  Values 

To  ascertain  whether  the  property  surrounding  the  sanatoria 
has  increased  or  decreased  in  value,  questions  were  asked  not 
only  to  determine  the  exact  value  of  surrounding  property  at 
the  time  of  opening  and  the  present  value,  but  also  whether  or 
not  building  operations  have  been  carried  on  in  the  neighbor- 
hood. A  tabulation  of  the  replies  to  these  queries  shows  that 
in  sixty-four  cases,  the  value  of  surrounding  property  has  in- 

13 


creased.  In  not  a  single  instance  of  the  eighty-four  reported 
has  the  value  decreased,  although  in  fourteen  cases,  the  value 
of  the  surrounding  property  has  remained  approximately  the 
same  as  it  was  when  the  sanatorium  was  opened.  Six  of  the 
answers  to  these  questions  were  not  sufficiently  definite  for 
classification. 

» 

Beneficial  Effect  of  Institutions 

Each  correspondent  was  asked  whether  his  sanatorium  has 
had  a  beneficial  or  detrimental  effect  upon  the  value  of  sur- 
rounding property.  Answers  to  this  question  show  that  in 
forty-eight  cases  sanatoria  have  had  a  direct  beneficial  effect 
on  the  value  of  surrounding  property.  In  only  three  cases  was 
any  indication  given  that  the  presence  of  the  sanatorium  has 
had  a  detrimental  effect,  although  in  twenty-one  cases  the  pres- 
ence of  the  sanatorium  apparently  has  had  no  effect  whatever, 
and  in  four  instances  the  possible  effect  has  been  doubtful. 
Eight  answers  to  this  question  were  not  definite  enough  for 
classification.  * 

An  Aid  to  Health 

In  answer  to  the  question  whether  the  sanatorium  has  had  a 
beneficial  or  detrimental  effect  upon  the  health  of  people  living 
near  it,  fifty-five  replied,  most  of  them  with  emphasis,  that  the 
presence  of  the  sanatorium  has  had  a  beneficial  effect,  while 
not  a  single  one  testified  to  a  detrimental  effect.  In  ten  cases, 
there  was  some  doubt  as  to  the  definite  benefit  of  the  institu- 
tion on  the  health  of  the  community,  and  in  six  it  seemed  to 
have  no  effect,  while  thirteen  did  not  answer  this  question  fully. 

Supplementing  the  foregoing  tabular  summary,  a  few  of  the 
more  interesting  comments  made  by  the  correspondents  in 
answering  the  questions  submitted  are  given : 

Increase  in  Property  Values 

The  following  answers  refer  to  the  question  asking  for  an 
opinion  on  the  effect  of  the  sanatoria  upon  the  value  of  sur- 
rounding property.  The  figures  in  parenthesis  refer  to  the  date 
of  opening  of  the  respective  institutions : 

*  See  page  19  for  opinions  on  this  subject. 

14 


From  A.  H.  Garvin,  M.D.,  Superintendent  of  the  State 
Hospital  for  Incipient  Tuberculosis  at  Ray  Brook,  New  York 
(1904) : 

"  The  actual  economic  value  of  Adirondack  forest  land  is,  in  my  opinion, 
about  $4  an  acre.  I  have  known  of  large  tracts  to  be  for  sale  at  $1  an  acre. 
A  fair  average  value  of  land  about  the  Saranac  country  is  $5  an  acre,  I  believe. 
The  fact  that  it  sells  for  more  is  solely  on  account  of  Saranac  Lake.  The 
hospital  land  cost  $20  an  acre,  at  least  twice  as  much  as  it  was  worth.  The 
land  in  the  immediate  vicinity  of  the  hospital  has  assumed  values  out  of  all 
proportion  to  its  actual  worth.  One  farm,  which,  in  the  central  part  of  the 
State  would  not  bring  more  than  $6,000  or  $7,000,  is  held  at  $15,000.  Plots 
of  land  near  the  hospital  are  selling  for  $100  an  acre.  One  kind  lady  who 
owned  a  small  plot  of  five  acres  adjoining  the  Sanatorium  property  kindly 
offered  to  sell  it  to  me  for  $8,000.     I  offered  her  $50. 

"  Of  course,  I  do  not  believe  that  Saranac  experience  or  special  health 
resort  experience  would  be  necessarily  paralleled  through  the  country. 
Falkenstein  Sanatorium,  of  course,  vastly  increased  the  value  of  the  property, 
but  this  was  the  second  pioneer  establishment  in  Germany,  and,  as  one  would 
say  in  business,  the  good  will  of  the  establishment  was  a  very  valuable  asset. 

"  Farm  lands,  especially  such  as  have  a  vantage  point  to  the  sanatorium 
for  supplies,  would  naturally  increase  very  much  in  value." 

From  David  Russell  Lyman,  M.D.,  Superintendent,  Gaylord 
Farm  Sanatorium,  Wallingford,  Conn.  (1904) : 
"All  land  in  our  vicinity  has  more  than  doubled  in  value." 

From  F.  H.  Dillingham,  M.D.,  Physician-in-chief,  St.  Joseph's 
Hospital,  now  located  in  a  thickly  settled  portion  of  New  York 

City  (1882): 

"  Property  increased  very  much.  Was  sparsely  settled  before  hospital  was 
built." 

From  Samuel  B.  English,  M.D.,  Superintendent,  New  Jersey 

Sanatorium   for   Tuberculous    Diseases,    Glen    Gardner,    N.    J. 

(1907): 

"  Increased  at  least  50  per  cent,  or  more  than  when  the  Sanatorium  was 
opened." 

From  Estes  Nichols,  M.D.,  Maine  Sanatorium,  Hebron,  Me. 
(1904): 

"  Increase  of  about  20  per  cent,  of  valuation  and  tax." 

From    C.     S.    Butts,    M.D.,     Superintendent,    Philadelphia 

Jewish  Sanatorium,  Eagleville,  Pa.  (1909) : 

"  Yes,  25  per  cent,  to  50  per  cent.  Property  which  had  been  long  for  sale 
has  all  been  sold.  Now  occupied.  New  homes  have  sprung  up  from  time 
to  time  and  at  present  quite  a  large  building  operation  within  four  squares 
of  the  sanatorium  is  nearing  completion,  all  residences." 

From  Ralph  Hunt,  M.D.,  Day  Camp  Anti-Tuberculosis 
League  of  the  Oranges  (1909) : 

"All  property  in  the  neighborhood  has  increased  in  value." 

15 


From  F.  M.  Pottenger,  M.D.,  Pottenger  Sanatorium,  Mon- 
rovia, California  (1903) : 

"  It  has  increased.  One  piece  of  eleven  acres  was  offered  me  at  §4,000. 
The  same  could  not  be  purchased  today  for  $30,000." 

From  H.  V.  Pettit,  M.D.,  Superintendent,  Ottawa  Tuber- 
culosis Colony,  Ottawa,  111.  (1904) : 

"  The  value  of  adjoining  property  was  temporarily  depressed  as  a  result 
of  our  presence,  but  within  two  years  afterward  it  commenced  to  increase  in 
value  and  now  has  increased  over  33§  per  cent,  above  its  value  at  the  time 
of  our  inception  (1904)." 

From  G.  F.  Sauer,  Superintendent,  The  Hospital  and  House 
of  Rest  for  Consumptives,  in  a  rapidly  developing  part  of 
New  York  City  (1869) : 

"  Increased  at  least  100  per  cent." 

From    Edward    L.     Trudeau,     M.D.,     Adirondack    Cottage 

Sanatorium,  Trudeau,  New  York  (1885) : 

"  First  purchase  $25  an  acre,  last  purchase  $1,000  an  acre.  Land  within 
our  gates  sold  to  us  for  $1,000  an  acre." 

From  Montgomery  E.  Leary,  M.D.,  Superintendent,  Monroe 

County  Hospital,  Rochester,  New  York  (1910) : 

"  Believe  land  has  increased.  A  considerable  number  of  new  dwelling- 
houses  have  been  erected  in  the  immediate  vicinity  since  the  institution 
was  started." 

From  Harry  Lee  Barnes,  M.D.,  Rhode  Island  State  Sana- 
torium, Wallum  Lake,  R.  I.  (1905) : 

"  Land  at  least  double  what  it  was  before  sanatorium  was  erected." 

From  Henry  D.  Chadwick,   Superintendent,  Westfield  State 

Sanatorium,  Westfield,  Mass.  (1910) : 

"  25  per  cent,  to  30  per  cent,  increase.  Two  adjoining  farms  during  the 
past  two  years  have  sold  for  considerable  advance  over  preceding  sales." 

No  Danger  of  Infection  Spreading 

The  most  frequent  objection  to  the  proposed  location  of  a 
hospital  is  that  it  will  be  a  menace  to  the  health  of  the  neigh- 
boring inhabitants.  The  following  interesting  comments  on 
this  point  are  in  answer  to  a  question  asking  directly  if  the  cor- 
respondents had  ever  known  of  any  case  of  infection  resulting 
from  the  presence  of  the  sanatorium: 

From  F.  M.  Pottenger,  M.D.,  Medical  Director  of  the  Pot- 
tenger Sanatorium,  Monrovia,  Calif.: 

"  I  do  not.  The  sanatorium  patient  is  the  best  educated  of  all.  He  learns 
in  the  sanatorium,  from  seeing  the  care  that  is  taken,  what  care  he  himself 

16 


should  take;  and  even  the  most  careless  have  this  drilled  into  them  to  such 
an  extent  that  they  will  be  more  careful  than  they  would  otherwise  be,  with- 
out such  training.  I  consider  a  well-conducted  sanatorium  the  least  dangerous 
of  all  places  for  people  to  live.  It  is  far  less  dangerous  than  the  average 
hotel  or  boarding  house." 

No  better  testimony  as  to  the  safety  of  an  institution  could 
be  found  than  in  the  attitude  of  life  insurance  companies  as 
indicated  in  the  remarks  of  H.  V.  Pettit,  M.D.,  Superintendent 
of  the  Ottawa  Tuberculosis  Colony,  Ottawa,  111.* 

"As  far  as  I  know  there  have  been  no  cases  of  tuberculosis  which  have  re- 
sulted from  residence  in  or  near  this  institution.  In  fact,  there  have  been 
several  of  our  officers  who  have  taken  out  life  insurance  with  one  of  the  most 
conservative  companies  in  this  country  and  have  been  advised  by  the  life 
insurance  company  that,  other  things  being  equal,  their  risk  is  better  than 
that  of  the  average  person." 

From  Martin  F.  Sloan,  M.D.,  Superintendent  of  Eudowood 
Sanatorium,  Towson,  Md. 

"  I  believe  the  wide  spread  fear  of  tuberculosis  patients  and  institutions 
to  be  not  only  unjust  but  unfounded.  The  public  should  be  willing  to  believe 
that  sanatorium  directors  fully  appreciate  the  gravity  of  the  situation  and 
therefore  do  every  thing  to  minimize  contagion.  They  should  also  know 
that  80  per  cent,  of  those  having  tuberculosis  and  knowing  it,  will  exercise 
prophylaxis.  It  is  the  person  who  has  the  undiagnosed  tuberculosis  lesion 
that  is  to  be  feared." 

From  Montgomery  E.  Leary,  M.D.,   Superintendent  of  the 

Monroe  County  Hospital,  Rochester,  N.  Y. : 

"A  well-conducted  sanatorium  is  the  safest  place  to  live  in.  You  know 
what  you  have;  on  the  outside  you  do  not  know  who  you  are  meeting  or 
what  they  are  doing.  With  properly  educated  patients  and  rules  which  are 
enforced,  there  are  more  dangers  on  the  street  than  in  the  sanatorium." 

From  Edward  L.  Trudeau,  M.D.,  Medical  Director,  Adiron- 
dack Cottage  Sanitarium,  the  first  of  its  kind  in  America, 
opened  in  1884: 

"  If  employees  don't  develop  the  disease  while  in  the  institution,  how 
could  the  sanatorium  possibly  endanger  anyone  outside  of  its  gates.  To 
my  knowledge,  no  healthy  employee  has  developed  the  disease  while  in  our 
institution." 

From  J.  W.  Coon,  M.D.,  Superintendent  of  the  State  Sana- 
torium, Wales,  Wis. : 

"  It  may  be  worthy  of  note  that  among  the  two  hundred  persons  who 
have  been  employed  at  the  sanatorium  since  its  opening,  by  far  the  larger 
proportion  of  whom  were  young  men  and  women,  at  the  most  susceptible 
age  for  contracting  tuberculosis,  not  one,  so  far  as  I  am  aware,  has  ever 
developed  tuberculosis,  although  one  or  two  had  already  contracted  it  before 
coming  to  the  institution.  It  seems  to  me  this  speaks  well  for  the  care  exer- 
cised in  preventing  the  spread  of  the  disease  from  the  institution." 

*  See  page  36. 

17 


From  Guy  L.  Kiefer,  M.D.,  Health  Officer  of  Detroit,  Mich.: 

"  I  am  sure  that  our  sanatorium  has  had  no  ill  effect  on  the  health  upon 
the  immediate  surrounding  community  and  I  am  equally  sure  all  the  prop- 
erty surrounding  our  hospital  has  advanced  in  value." 


Opposition  Does  Not  Last 

That  the  chief  opposition  to  a  hospital  will  die  out  after  it 
has  been  established  and  the  people  understand  its  functions  is 
amply  attested  by  the  following  quotations: 

From    Robert    A.    Peers,    M.D.,    Medical    Director,    Colfax 

School   and   Hospital   for  the  Tuberculous,  Colfax,  California 

(1908) : 

"  When  we  first  commenced  our  work  here,  there  was  a  good  deal  of  oppo- 
sition and  it  was  even  made  a  political  issue,  but  now  people  try  to  secure 
patients  and  their  families  as  tenants  and  as  a  result  many  new  houses  have 
been  built  that  would  not  otherwise  have  been  erected.  Directly  and  indi- 
rectly the  town,  which  has  about  750  steady  inhabitants,  profits  to  the  extent 
of  several  hundred  dollars  a  month  and  there  has  been  no  mortality  or  morbid- 
ity amongst  the  local  inhabitants.  In  the  fourteen  years  I  have  been  here, 
but  two  of  the  townspeople  have  died  from  tuberculosis." 

From  Ralph  H.  Hunt,  M.D.,  Day  Camp  Anti-Tuberculosis 

League,  Orange,  N.  J.  (1909) : 

"At  the  time  of  the  establishment  of  our  camp,  there  was  very  marked 
objection  to  it  on  the  part  of  the  neighbors,  which  was  so  acute  that  it  took 
the  form  of  an  injunction.  We,  however,  beat  the  injunction.*  Since  that 
time  the  whole  attitude  of  the  neighbors  has  changed,  and  many  of  them 
are  good  friends  today,  and  so  far  as  I  know  at  the  present  time  there  is 
no  objection  at  all." 

From  Charles  S.  Millet,  M.D.,  Medical  Director,  Millet 
Memorial  Hospital,  East  Bridgewater,  Mass.  (1900) : 

"  There  was  considerable  opposition  among  the  neighbors  to  the  sana- 
torium when  it  was  first  established,  on  account  of  their  fears,  but  that  has 
long  since  disappeared." 

Herbert  Maxon  King,  M.D.,  Loomis  Sanatorium,  Liberty, 
New  York  (1896),  testifies  that  in  spite  of  initial  opposition, 
property  surrounding  the  hospital  has  increased  in  value  and 
that  the  institution  has  had  a  beneficial  effect,  and  sums  up  his 
remarks  thus : 

"  I  am,  of  course,  a  prejudiced  party  to  such  an  inquiry,  but  my  state- 
ments have  been  acceded  to  by  business  men,  railway  officers,  local  resi- 
dents, etc.,  in  this  vicinity,  notwithstanding  many  bitter  attacks  upon  the 
sanatorium  in  times  past." 

*  See  page  41. 

18 


From  Isaac  W.  Brewer,  M.D.,  Superintendent  of  the  Tomp- 
kins County  Tuberculosis  Hospital,  Ithaca,  N.  Y.  (1913): 

"  There  has  been  considerable  opposition  to  the  establishment  of  sana- 
toria for  the  treatment  of  tuberculosis,  on  the  grounds  that  the  value  of 
the  local  property  will  be  depressed.  When  this  site  was  chosen,  there  was 
the  usual  objection.  However,  that  seems  to  have  passed  away  for  during 
the  past  three  months  both  of  the  farms  that  adjoin  the  sanatorium  have 
been  sold.  The  one  directly  opposite  the  buildings,  a  fruit  farm,  sold  for 
$200  per  acre,  and  the  one  that  adjoins  us  on  the  south  sold  for  $4,500,  and 
would  have  brought  $5,000  but  for  a  matter  of  personal  feeling  between  cer- 
tain persons.  All  those  who  live  in  this  community  believe  that  both  farms 
brought  all  that  they  were  worth. 

"  The  secretary  of  one  of  the  largest  real  estate  companies  in  Ithaca  in- 
forms me  that  he  does  not  think  the  sanatorium  has  in  any  way  changed 
the  values  of  the  land  in  its  vicinity." 

Hospitals  Benefit  Health  of  Neighbors 

A  few  answers  to  the  question  "Has  your  institution  had  any 
beneficial  effect  upon  the  health  of  those  living  near  it  by  educating 
them  to  open  their  windows,  etc.,"  may  well  be  included. 

From  John  C.  King,  M.D.,  Superintendent  of  Dr.  King's 
Sanatorium,  Banning,  California: 

"  The  beneficent  sleeping-porch  fad  has  become  general  in  the  town." 

From  Henry  D.  Chadwick,  M.D.,  Superintendent,  Westfield 

State  Sanatorium,  Westfield,  Massachusetts: 

"  I  am  sure  that  it  has.  Many  new  dwelling  houses  are  adding  sleeping 
porches  and  outdoor  sleeping  is  becoming  quite  common." 

From  Theodore  B.  Sachs,  M.D.,  Edward  Sanatorium,  Naper- 

ville,  111.: 

"  Less  indiscriminate  expectoration  in  public  places.  Windows  kept 
open  at  night  in  the  majority  of  residences.  Residences  built  with  sleeping 
porches.  I  believe  that  the  nearness  of  a  tuberculosis  sanatorium  to  a  com- 
munity has  a  beneficial  effect  upon  the  standard  of  health  of  said  community 
as  well  as  a  tendency  to  increase  the  value  of  surrounding  property." 

From  Thomas  N.  Hay,  M.D.,  River  Pines  Sanatorium, 
Stevens  Point,  Wisconsin: 

"  Yes,  a  large  number  of  sleeping  porches  have  been  built  in  the  town.-' 

An  Exception 

The  following  statement  by  W.  M.  Mills,  M.D.,  formerly 
Medical  Director  of  the  Camp  of  the  Topeka  (Kansas)  Asso- 
ciation for  the  Study  and  Prevention  of  Tuberculosis  gives  the 
only  experience  of  the  kind  out  of  the  eighty-four  institutions. 

19 


The  small  temporary  camp,  located  in  a  growing  section  of  the 
city,  was  already  in  operation  when  some  question  of  adminis- 
tration aroused  opposition.     To  quote  Dr.  Mills: 

"  We  have  been  compelled  to  abandon  our  camp  on  account  of  pressure 
brought  to  bear  by  neighboring  property  owners  on  the  owner  of  the  land 
we  lease.  They  think  that  their  property  values  would  have  increased  if 
we  had  not  been  near  them.  Property  owners  say  that  property  around  the 
camp,  which  was  in  a  'fairly  well  settled'  section,  had  not  decreased  in  value 
but  became  more  difficult  to  sell." 


20 


CHAPTER  III 


Assessed  Property  Values  Around  Five 
Institutions 

In  order  to  verify  as  accurately  as  possible  existing  informa- 
tion with  regard  to  the  effect  of  a  tuberculosis  hospital  upon  the 
value  and  desirability  of  surrounding  property,  as  summarized 
in  preceding  chapters,  a  first-hand  investigation  was  made  of 
five  institutions  which  seem  to  be  typically  located  in  relation 
to  city,  village,  or  farming  district,  for  the  particular  purpose 
of  studying  assessed  valuation  and  special  factors  affecting  the 
problem.*  Of  the  five  hospitals  considered,  one  was  located 
within  limits  of  a  large  city;  one  just  within  limits  of  a  city  of 
85,000;  one  just  outside  the  limits  of  a  city  of  35,000;  one  on 
the  outskirts  of  a  village  of  300;  and  one  in  a  farming  district 
2 1  miles  from  a  village  of  8,000. 

Information  in  each  case  was  collected  covering  the  following 
points : 

(1)  The  change  in  assessed  valuation  of  surrounding  property 
after  the  locating  of  a  hospital ; 

(2)  Actual  sales  of  surrounding  property; 

(3)  Expressed  feeling  of  nearby  property  owners;   and 

(4)  Expressed  feeling  of  general  public. 

Each  hospital  will  be  considered  where  information  is  available 
individually  under  these  four  heads : 

I.     HOSPITAL  WITHIN  LIMITS  OF  LARGE  CITY 

Seton  Hospital,  New   York  City. 

This  semi-charitable  hospital,  located  within  the  limits  of 
New  York  City  and  opened  in  1894,  accommodates  375  men, 
women  and  children,  largely  indigent,  and  chiefly  in  the  advanced 

*  The  investigations  noted  in  this  chapter  were  made  for  the  National  Association  by 
Dixon  Van  Blarcom,  Field  Secretary. 

21 


stages  of  the  disease.  The  grounds  comprise  a  city  block  in 
the  centre  of  a  high  class  residential  section.  Roads  have  been 
cut  through  part  of  the  section  and  part  still  remains  wooded. 
The  hospital  is  situated  on  a  ridge  which  slopes  on  the  one  hand 
to  the  Hudson  River  and  on  the  other  to  a  more  thickly  settled 
portion  of  the  city.  Real  estate  firms  and  individuals  have 
improved  their  holdings  with  privately  built  roads  and  sewers. 
The  whole  crest  of  the  ridge  is  not  immediately  accessible  by 
public  transportation  facilities  and  since  property  owners  have 
opposed  the  building  of  a  street  car  line  through  the  section, 
the  property  has  been  acquired  and  is  being  built  up  by  the  more 
well-to-do  class.  Many  fine  homes  have  been  built  in  the 
direction  of  the  river  and  to  the  south  of  the  hospital.  There 
are  also  a  number  of  residences  to  the  north. 

The  main  building  of  the  hospital  is  located  within  200  feet 
and  in  full  view  of  the  street  which  runs  along  the  crest  of 
the  hill.  The  hospital  was  erected  when  surrounding  property 
was  comparatively  cheap  and  the  neighborhood  sparsely  settled. 
The  property  has  increased  enormously  in  value  and  has  become 
more  and  more  desirable  for  residences  which  are  being  grad- 
ually built. 

1.    Assessed  Valuation* 

Since  1900  (the  earliest  figures  obtained)  adjoining  and  nearby 
property  has  increased  from  two  to  six  times  in  assessed  valua- 
tion. The  hospital  was  given  as  the  reason  in  the  applications 
for  reductions  of  assessed  valuation  recently  by  the  owners  of 
two  or  three  small  parcels  of  land  directly  across  the  street  from 
the  hospital.  It  will  be  noted  from  the  figures  of  one  of  these 
parcels  given  in  the  following  table  that  the  decrease  in  assess- 
ment was  preceded  by  a  marked  increase,  which  is  typical  of 
other  surrounding  property : 

Year 1900        1905        1910        1913 

Valuation $2,200    $5,500    $8,500    $7,000 

A  county  official's  comment  on  these  applications  was:  "Any 
excuse  is  sufficient  grounds  upon  which  to  base  an  application 
for  a  reduction  in  assessment." 

An  examination  of  the  tables  in  the  Appendix  will  show  that 
an  occasional  property   some  distance  from  the  hospital  has 

*  See  Appendix,  page  54,  for  tables  giving  detailed  figures. 

22 


decreased  in  assessed  valuation  after  a  remarkable  increase,  so 
that  no  importance  can  be  attached  to  similar  changes  in  ad- 
joining property. 

2.  Actual  Sales 

The  sales  have  not  been  numerous,  because  as  one  man, 
whose  father  lives  within  a  block  of  the  hospital,  expressed  it, 
"  The  people  who  own  property  there  would  not  sell  at  any 
price."  And  again,  some  large  tracts  belong  to  old  estates  and 
other  owners  have  built  homes  in  which  they  now  live.  One 
residence  recently  constructed  within  200  or  300  feet  of  the 
hospital  has  remained  unrented  for  about  four  months  because 
prospective  occupants  object  that  it  is  too  near  the  hospital. 
It  had  been  occupied  by  a  man  who  left,  not  because  of  the 
hospital,  but  for  an  extended  trip  in  Europe.  A  member  of 
the  real  estate  firm  which  controls  the  house  says  that  this  is 
the  only  instance  of  the  kind  of  which  he  knows.  It  is  one  of 
the  two  or  three  homes  which  are  so  close  to  the  hospital  that 
the  coughing  of  patients  is  sometimes  audible  in  summer. 

3.  Feeling  of  Property  Owners 

The  head  of  one  realty  company  with  considerable  interest 
in  nearby  property,  gave  the  impression  that  the  hospital  has 
some  undesirable  influence  upon  the  immediately  adjoining 
property,  but  that  it  probably  does  not  extend  any  considerable 
distance  from  the  grounds. 

In  1910,  Mr.  B  built  a  fine  new  home  about  200  yards  from  the 
hospital.  He  has  no  objection  except  to  the  appearance  of  an 
unkempt  incinerator  on  the  grounds. 

Mr.  C  lives  in  a  home  just  beyond  Mr.  B  and  owns  some  prop- 
erty in  the  vicinity.  He  does  not  object  to  the  hospital  but 
believes  it  affects  somewhat  the  value  and  chances  of  sale  of 
adjoining  property.  Mr.  D,  who  lives  in  the  vicinity  and  holds 
considerable  property,  believes  the  hospital  has  some  depre- 
ciating effect  but  cannot  say  how  much. 

Mr.  E  in  1910  built  a  new  home  nearer  the  hospital  by  the 
width  of  the  street  than  Mr.  B,  after  he  had  lived  in  a  rented 
house  on  the  hill  for  a  year.  The  building  of  a  home  so  near 
the  hospital  by  this  intelligent  lawyer  after  he  had  lived  in  the 

23 


neighborhood  long  enough  to  become  thoroughly  familiar  with 
the  situation  is  the  best  possible  comment  on  the  effect  of  the 
hospital  on  the  desirability  of  surrounding  property. 

4.    Feeling  of  General  Public 

Little  opportunity  was  had  for  obtaining  general  sentiment, 
but  those  interviewed  at  random  expressed  friendly  feelings. 
The  tax  assessor  said  that  the  hospital  was  taken  into  consider- 
ation in  fixing  the  assessments  of  adjoining  property. 

II.     HOSPITAL  WITHIN  CITY  OF  85,000 

Sprain  Ridge  Hospital,   Yonkers,  New   York. 

This  semi-charitable  and  splendidly  equipped  hospital; 
located  in  a  sparsely  settled  section  within  the  limits  of  a  city 
of  85,000  population,  was  opened  in  1908  with  a  capacity  for 
twenty-five  incipient  cases,  who  are  charged  a  nominal  rate  for 
treatment.  The  buildings  are  set  some  distance  back  from  the 
road  and  are  visible  from  a  few  points  only.  Adjoining  the 
property  is  a  cemetery  which  property  owners  say  depreciates 
the  value  of  all  land  in  the  neighborhood. 

1.  Assessed  Valuation  * 

Both  the  adjoining  and  nearby  property  has  increased  steadily 
in  assessed  valuation  since  the  hospital  was  erected.  The  ad- 
joining property  increased  fifty-seven  per  cent,  from  1907  to 
1914.  Property  not  adjoining  the  hospital  grounds,  but  in  the 
immediate  vicinity  increased  fifty-one  per  cent,  during  the  same 
period. 

2.  Active  Sales 

Several  adjoining  and  nearby  tracts  have  changed  hands  or 
have  been  divided  into  building  lots  which  are  now  on  the 
market.  One  adjoining  plot  of  over  200  acres  was  bought  in 
1905  at  about  $500  per  acre  and  in  1910,  thirty-three  acres  of  it 
were  sold  for  about  $2,000  an  acre.  One  part  of  an  adjoining 
property  of  forty-five  acres,  which  cost  $800  an  acre  in  1911 , 
has  been  cut  up  into  one-quarter  acre  lots  and  sold  at  the  rate 
of  $2,000  to  $2,800  an  acre.     Seventy  one-quarter  acre  lots 

*  See  Appendix,  page  56,  for  detailed  figures. 

24 


nearby  have  brought  from  $250  to  $500  each  in  the  past  five 
years.  Thirty  new  homes  valued  at  from  $8,000  to  $15,000 
each,  including  the  lots,  have  been  erected  in  the  past  two  years 
on  one  plot  three-quarters  of  a  mile  from  the  hospital  grounds. 
These  transactions  are  typical  of  the  activity  of  both  adjoining 
and  nearby  property. 

3.    Feeling  of  Property  Owners 

Owners  of  adjoining  and  nearby  property  are  nearly  unani- 
mous in  stating  that  the  hospital  has  very  little  if  any  effect 
upon  their  property.  The  owners  of  fifty  acres  adjoining  did 
not  mention  the  hospital  as  a  reason  in  their  application  for  a 
reduction  of  assessed  valuation  in  1913.  Both  owners  said 
they  thought  the  hospital  had  no  effect. 

The  owner  of  a  thirty-eight  acre  adjoining  plot  recently  gave 
the  cemetery,  water  works  and  hospital,  all  of  which  adjoin  him, 
as  reasons  for  a  reduction  in  assessed  valuation. 

Another  man  owning  a  large  tract  across  the  road  from  the 
hospital  said  it  has  not  had  any  serious  effect.  The  owner  of 
eighteen  acres  adjoining  made  favorable  comment  upon  the 
improvement  of  the  hospital  tract  with  the  coming  of  the  insti- 
tution. 


III.    HOSPITAL  WITHIN  HALF-MILE  OF  CITY 
OF  35,000 

Bowne  Memorial  Hospital,  Poughkeepsie,    New    York. 

This  is  a  public  hospital,  built  as  a  memorial  and  given  to  the 
county,  with  accommodations  for  seventy-five  adults  in  all 
stages  of  the  disease  and  twenty-five  children.  It  is  located 
one-half  mile  outside  the  limits  of  the  city  of  Poughkeepsie. 
The  buildings  are  on  an  eminence  about  one  hundred  yards  from 
one  of  two  crossing  highways  and  about  one  hundred  feet  from 
the  other  and  in  full  view  from  both  of  them.  Property  toward 
the  city  is  built  up  here  and  there  with  homes  chiefly  of  work- 
ing men,  while  on  the  other  side  it  is  divided  into  small  farms. 
A  camp  opened  upon  the  site  in  January,  1910,  gave  way  to 
permanent  hospital  buildings  in  1911,  which  were  enlarged  in 
1913. 

25 


1.  Assessed  Valuation 

The  assessed  valuation  of  the  surrounding  property  rose 
uniformly  from  1908  to  1912,  as  is  indicated  in  the  tables  shown 
in  the  appendix.  * 

2.  Actual  Sales 

There  have  been  few  changes  in  ownership  of  surrounding 
property  since  the  institution  was  opened  as  the  owners  do  not 
seem  desirous  of  selling. 

Mr.  A  recently  refused  $3,500  for  a  four-acre  plot  now  ad- 
joining the  hospital  grounds  and  for  which  he  paid  about  $2,000 
before  the  hospital  was  built.  Mr.  B  lately  declined  an  offer 
of  $20,000  for  eighty  acres  of  adjoining  property  assessed  at 
$6,600.  Mr.  C  recently  refused  $30,000  for  forty-one  acres 
located  one-quarter  of  a  mile  from  the  hospital  in  the  direction 
of  the  city  and  assessed  for  $10,000. 

3.  Feeling  of  Property  Owners 

One  man  owning  eighty  acres  across  the  road  from  the  hos- 
pital thought  that  it  made  no  difference  whatever.  However, 
a  man  owning  twelve  acress  across  the  road  in  another  direction 
claims  that  the  hospital  injures  his  property  and  strongly  dis- 
approves of  its  location.  The  owner  of  a  small  plot  about  one- 
quarter  of  a  mile  from  the  hospital  stated  that  a  prospective 
buyer  objected  to  the  hospital  on  the  grounds  that  it  would  be 
a  danger  to  her  child.  He  further  stated,  however,  that  he  knew 
there  was  no  danger  and  had  no  complaint  to  make,  but  was  in 
entire  sympathy  with  the  hospital.  The  head  of  one  improve- 
ment company  with  large  tracts  one-quarter  of  a  mile  from  the 
hospital  said  that  he  was  sure  it  made  no  difference  whatever. 
The  other  property  owners  interviewed  agreed  that  the  hospital 
is  no  detriment. 

4.  Feeling  of  General  Public 

One  county  official  was  of  the  opinion  that  the  hospital  af- 
fected immediately  adjoining  property  to  some  extent.  Other 
opinions  obtained  were  favorable. 

*  See  Appendix,  page  56,  for  detailed  figures. 

26 


5ET0N 
HOSPITAL 

Nrw  "Ti.HK  Ciry 
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IV.     HOSPITAL  NEAR  VILLAGE  OF  300 

Montefiore  Home  Country  Sanatorium,  Bedford 
Station,  New  York. 

This  Jewish  charitable  hospital  of  170  capacity  primarily 
for  incipient  cases,  is  located  upon  a  hill  overlooking  a  village 
of  300  population.  The  institution  is  one-half  mile  from  the 
railroad  station  and  some  thirty  miles  from  New  York  City, 
from  which  practically  all  of  its  patients  come.  The  village 
lies  on  one  side  of  the  sanatorium,  while  on  the  other  three  sides 
the  land,  which  is  of  rough,  hilly  formation,  is  occupied  by  a 
few  country  homes  and  a  number  of  somewhat  unproductive 
farms.  The  buildings  of  the  institution  are  located  in  full  view 
of  the  highway. 

1.    Assessed  Valuation 

Since  1903,  the  adjoining  and  nearby  property  has  increased 
in  assessed  valuation  at  a  rate  normal  for  its  type.  It  will  be 
noted  that  the  assessment  figures*  do  not  date  from  the  opening 
of  the  hospital,  1897,  but  from  a  period  several  years  later.  The 
rise  in  assessed  valuation  does  not  seem  to  have  kept  pace  with 
the  increase  in  estimated  value  of  the  property  or  with  the  in- 
crease as  indicated  by  sales. 

2.    Actual  Sales 

While  a  large  amount  of  surrounding  property  belongs  to 
old  estates  and  is  not  for  sale,  land  which  has  been  sold  has 
brought  an  increase  over  the  purchase  price,  and  in  some  in- 
stances a  marked  increase. 

One  plot  of  seventy-six  acres  adjoining  the  hospital  was 
purchased  for  $12,500  after  the  hospital  was  erected  and  sold 
shortly  afterward  for  $22,000.  Three  parcels  of  nearby  prop- 
erty which  was  purchased  ten  years  ago  for  $18,000  were  sold 
recently  for  $73,000.  Three  parcels  remain.  Mr.  X  claims 
that  his  eighty-five  acres  of  adjoining  property  bought  about 
thirty  years  ago  for  $10,000  is  now  worth  $40,000. 

Mr.  C  values  at  $18,000  eighty  acres  of  adjoining  property 
for  which  he  paid  $9,000.  One  owner  values  at  $70,000  one 
hundred  and  forty  acres  of  adjoining  land  for  which  he  paid 


*  See  Appendix,  page  57,  for  detailed  figures. 

27 


$35,000.  Another  owner  questions  if  he  would  now  take  $400 
an  acre  for  seventy  acres  of  adjoining  property  for  which  he  paid 
about  $75  an  acre  a  few  years  ago. 

The  property  of  a  real  estate  development  company  one-half 
mile  from  the  hospital  which  cost  $16,000  ten  years  ago  is  now 
valued  at  about  $60,000. 

3.  Feeling  of  Property  Owners 

While  property  owners  were  somewhat  divided  in  their 
opinions  as  to  the  effect  of  the  hospital  upon  the  surrounding 
property,  the  majority  were  firm  in  believing  that  it  has  no  mat- 
erial effect.  For  example,  one  owner  of  adjoining  property 
believes  the  hospital  has  an  undesirable  effect  and  says  he  is 
anxious  to  sell;  another  expressed  the  wish  that  it  be  removed 
from  the  locality;  while  the  owner  of  130  acres  adjoining  held 
that  the  hospital  had  very  little  if  any  effect;  and  another  said 
it  had  none  at  all. 

4.  Feeling  of  General  Public 

The  attitude  of  the  villagers  is  friendly  with  a  few  exceptions 
in  which  the  feeling  of  opposition  is  in  no  sense  bitter  or  strong. 
The  type  of  friends  of  the  patients,  who  visit  patients  at  the 
hospital,  and  their  actions  in  the  village,  were  the  chief  target 
for  such  criticisms  and  objections  as  were  offered  by  both  prop- 
erty owners  and  villagers.  This  is  a  situation  which  would 
probably  not  be  duplicated  in  any  other  part  of  the  country, 
owing  to  the  fact  that  the  sanatorium  population  is  largely 
Jewish,  from  congested  portions  of  New  York,  and  the  visitors 
are  of  a  similar  descent. 

V.     HOSPITAL  LOCATED  IN  FARMING  DISTRICT 

Gaylord  Farm  Sanatorium,    Wallingford,   Conn. 

This  semi-charitable  institution  strictly  for  incipient  cases,  is 
located  in  the  country  about  two  and  one-half  miles  from  a 
village  of  8,000  inhabitants  and  a  few  miles  from  New  Haven. 
Patients  are  charged  a  nominal  rate  and  the  deficit  is  made  up 
by  private  subscriptions  and  state  subsidy.  The  buildings  are 
one-eighth  of  a  mile  back  from  the  road  and  in  full  view  from  it. 
Possible  future  complaints  are  eliminated  by  the  fact  that  the 

28 


hospital  owns  the  property  across  the  highway.     Small  farms 
and  wooded  land  comprise  the  adjoining  and  nearby  property. 

1.  Assessed  Valuation  * 

The  largest  part  of  the  surrounding  property  shows  an  in- 
crease in  assessed  valuation  from  1903,  the  year  before  the  insti- 
tution was  opened,  to  1913.  The  unchanged  assessment  of  a 
few  parcels  of  land  is  not  unusual  for  this  type  of  property,  which 
increases  in  value  slowly  and  at  infrequent  intervals. 

2.  Actual  Sales 

Little  of  the  property  in  the  neighborhood  has  changed 
hands  in  the  past  few  years  with  the  exception  of  that  bought 
up  at  times  by  the  hospital. 

An  adjoining  farm  which  cost  $25  an  acre  the  year  before  the 
hospital  opened  brought  $50  an  acre  six  years  later.  Sixty 
acres  of  nearby  property  assessed  for  $1,797  was  sold  for  $2,900 
two  years  ago.  Recently  a  property  within  a  mile  of  the  hos- 
pital assessed  at  $7,788  was  sold  for  $9,000. 

3.  Feeling  of  Property  Owners 

The  property  owners  interviewed  did  not  feel  that  the  hospital 
had  a  detrimental  effect  upon  their  property  nor  did  they  feel 
that  it  was  undesirable. 

4.  Feeling  of  General  Public 

It  is  worthy  of  note  that  the  feeling  in  the  village  seemed 
to  be  entirely  friendly.  The  institution  was  frequently  re- 
ferred to  witn  some  pride.  This  friendly  feeling  may  be  due 
in  some  degree  to  the  fact  that  the  hospital,  partly  with  its  own 
money,  has  made  improvements  in  nearby  highways.  The  insti- 
tution doubtless  helps  also  to  relieve  the  loneliness  of  the  district. 


*  See  Appendix,  page  58  for  detailed  figures. 


29 


CHAPTER  IV 


Typical  Laws  and  Ordinances  Covering 

the  Approval  and  Restriction  of 

Hospital  Sites 

The  rapid  increase  in  the  number  of  hospitals  and  sanatoria, 
particularly  in  New  York  and  New  Jersey,  combined  with  a 
constant  succession  of  local  conflicts  over  the  location  of  such 
institutions  has  led  several  states  and  a  number  of  cities  to  enact 
legislation  bearing  on  this  problem.  The  laws  of  New  York 
and  New  Jersey  are  the  most  comprehensive  and  suggestive 
ones  on  this  subject,  and  on  this  account  are  given  in  full.*  As 
most  of  the  restrictive  ordinances  are  similar  in  general  form 
only  one  of  them  is  given  in  full. 

New  York 

The  New  York  State  law  covering  the  approval  of  sites  for 
tuberculosis  hospitals  was  enacted  in  1909,  after  a  vain  attempt 
had  been  made  to  secure  a  site  for  a  sanatorium  on  Long  Island 
under  then  existing  legislation.  As  a  result  of  this  law,  this 
sanatorium  and  many  others  have  been  established  without 
recourse  to  the  somewhat  burdensome  machinery  of  the  courts. 
The  law  provides:  (1)  that  the  State  Commissioner  of  Health 
and  the  health  officer  of  the  locality  in  which  it  is  proposed  to 
locate  the  institution  shall  sit  as  judges  at  a  previously  advertised 
public  hearing  on  the  question  and  render  a  decision  within 
thirty  days;  and  (2)  that  if  they  are  unable  to  agree,  an  appeal 
may  be  made  to  a  committee  comprised  of  the  State  Commis- 
sioner of  Health,  the  Lieutenant  Governor  and  the  Speaker  of 
the  Assembly,  who  constitute  a  final  court  for  the  decision  of 
matters  pertaining  to  the  location  of  tuberculosis  hospitals  and 
sanatoria. 

The  text  of  the  law,  which  is  Section  319  of  Chapter  49  of 
the  Consolidated  Laws  of  1909,  follows: 


*  Rhode  Island  also  has  a  special  law  passed  in  1909,  dealing  with  this  problem. 

30 


Section  319.  Consents  requisite  to  the  establishments  of  hospitals  or 
camps  for  the  treatment  of  pulmonary  tuberculosis. — A  hospital,  camp  or 
other  establishment  for  the  treatment  of  patients  suffering  from  the  disease 
known  as  pulmonary  tuberculosis,  shall  not  be  established  in  any  town  by 
any  person,  association,  corporation  or  municipality  except  when  authorized 
as  provided  by  this  section.  The  person,  association,  corporation  or  munici- 
pality proposing  to  establish  such  a  hospital,  camp  or  other  establishment 
shall  file  with  the  state  commissioner  of  health  a  petition  describing  the 
character  thereof,  stating  the  county  and  town  in  which  it  is  to  be  located 
and  describing  the  site  in  such  town  for  such  proposed  hospital,  camp  or 
other  establishment,  and  requesting  the  commissioner  to  fix  a  date  and  place 
for  a  hearing  on  such  petition  before  the  state  commissioner  of  health  and 
the  local  health  officer,  who  shall  constitute  a  board  to  approve  or  disapprove 
the  establishment  of  such  hospital,  camp  or  other  establishment  in  accordance 
with  such  petition.  The  state  commissioner  of  health  shall  fix  a  date  and 
place  for  a  hearing  on  such  petition,  which  date  shall  be  not  less  than  thirty 
nor  more  than  forty  days  after  the  receipt  thereof.  A  notice  of  such  hearing 
specifying  the  date  and  place  thereof  and  briefly  describing  the  proposed 
site  for  such  hospital,  camp  or  other  establishment  shall  be  mailed  to  the 
person,  association,  corporation  or  municipality  proposing  to  establish  the 
same  and  to  the  health  officer  and  each  member  of  the  board  of  health  of 
the  town  in  which  it  is  proposed  to  establish  such  hospital,  camp  or  other 
establishment  at  least  twenty  days  before  the  hearing,  and  also  publish  twice 
in  a  local  newspaper  of  the  town,  or  if  there  is  no  such  paper  published  there, 
then  in  the  newspapers  of  the  county  designated  in  pursuance  of  law  to 
publish  the  session  laws.  At  the  time  and  place  fixed  for  such  hearing  the 
state  commissioner  of  health  and  the  local  health  officer  shall  hear  the  peti- 
tioner and  any  person  who  desires  to  be  heard  in  reference  to  the  location  of 
such  hospital,  camp  or  other  establishment,  and  they  shall  within  thirty 
days  after  the  hearing,  if  they  are  able  to  agree,  approve  or  disapprove  of 
the  location  thereof  and  shall  notify  the  person,  association,  corporation  or 
municipality  of  their  determination.  The  determination  of  the  state  com- 
missioner of  health  and  local  health  officer  shall  be  final  and  conclusive; 
but  if  within  thirty  days  after  the  hearing  they  are  unable  to  agree,  they 
shall  within  such  thirty  days  notify  the  person,  association,  corporation  or 
municipality,  proposing  to  establish  such  hospital,  camp  or  other  estab- 
lishment that  they  are  unable  to  agree.  Within  ten  days  after  the  receipt 
of  such  notice,  such  person,  association,  corporation  or  municipality  may 
file  in  the  office  of  the  state  commissioner  of  health  a  request  that  the  petition 
be  referred  to  a  board  consisting  of  the  lieutenant-governor,  the  speaker  of 
the  assembly  and  the  state  commissioner  of  health.  Such  officers  shall  ap- 
prove or  disapprove  of  the  proposed  location  of  such  hospital,  camp  or  other 
establishment  after  a  hearing  of  which  notice  shall  be  mailed  to  the  person, 
association,  corporation  or  municipality  proposing  to  establish  the  same  and 
to  the  health  officer  and  to  each  member  of  the  board  of  health  of  the  town, 
or  without  a  hearing,  upon  the  evidence,  papers  and  documents  filed  with  the 
state  commissioner  of  health  or  that  may  be  submitted  to  them,  as  the  board 
shall  determine.  They  shall  make  their  determination  within  thirty  days 
after  the  request  for  such  submission  has  been  filed  in  the  office  of  the  state 
commissioner  of  health  and  cause  a  copy  thereof  to  be  mailed  to  the  person, 
association,  corporation  or  municipality  proposing  to  establish  such  hospital, 
camp  or  other  establishment  and  to  the  health  officer  of  the  town  in  which 
it  is  proposed  to  establish  the  same.  Such  determination  shall  be  final  and 
conclusive. 


New  Jersey 

The  New  Jersey  law  is  significant  in  that  it  provides  for  a 
somewhat  simpler  procedure.     The  State  Board  of  Health  is 

31 


the  only  and  final  court  for  the  decision  of  questions  relating 
to  tuberculosis  institutions.  The  text  of  the  law,  which  is 
contained  in  Chapter  88  of  the  laws  of  1910,  follows: 

1.  Hereafter  no  person  or  persons,  corporation  or  association  shall  locate, 
construct  or  establish  in  any  city,  town,  borough,  township  or  other  muni- 
cipality of  this  State  any  hospital,  sanatorium,  preventorium  or  other  insti- 
tution to  be  used  for  the  care,  board  or  treatment  of  any  person  or  persons 
afflicted  with  the  disease  known  as  pulmonary  tuberculosis,  without  first 
obtaining  the  consent  and  approval  of  the  State  Board  of  Health  so  to  do. 

2.  All  applications  under  this  act  shall  be  made  to  the  State  Board  of 
Health  in  writing,  signed  by  the  applicant,  shall  give  the  name  of  the  city, 
town,  borough,  township  or  other  municipality  in  which  it  is  proposed  to 
locate  the  same,  and  shall  be  accompanied  with  a  descriptive  map  of  the 
premises  proposed  to  be  devoted  to  the  uses  authorized  by  this  act. 

3.  The  State  Board  of  Health  shall  fix  a  time  and  place  for  the  hearing 
on  such  application,  of  which  hearing  the  applicant  shall  give  at  least  two 
weeks'  notice  in  some  newspaper  published  and  circulating  in  the  munici- 
pality named  in  the  application,  and  if  none  be  published  therein,  then  by 
posting  in  such  municipality  at  least  ten  notices  for  fifteen  days  before  such 
hearing,  giving  notice  of  such  application. 

4.  At  the  time  and  place  so  fixed  for  said  hearing  the  State  Board  of 
Health  shall  hear  all  parties,  both  for  and  against  said  application,  and  said 
board  shall  thereupon  either  grant  or  withhold  the  consent  and  approval 
asked  for. 

5.  After  the  passage  of  this  act  the  State  Board  of  Health  shall  have  the 
sole  authority  to  grant  or  refuse  the  consent  and  approval  to  the  erection, 
construction,  and  establishing  of  any  and  all  hospitals,  sanatoria,  preven- 
toria,  or  other  institutions  designed  for  the  care,  board  or  treatment  of  any 
person  or  persons  afflicted  with  the  disease  known  as  pulmonary  tuberculosis. 

6.  After  the  passage  of  this  act  no  consent  shall  be  required  from  any 
officer  or  board  of  the  State  of  New  Jersey  or  any  of  the  municipalities  there- 
of, except  the  State  Board  of  Health  as  aforesaid,  to  the  erection,  construc- 
tion or  establishment  of  any  of  the  institutions  aforesaid,  or  to  the  bringing 
of  persons  to  such  institutions  from  points  within  or  without  the  State. 

7.  This  act  shall  not  be  construed  to  require  any  of  the  institutions  afore- 
said which  may  have  been  used  prior  to  the  passage  of  this  act  during  the 
summer  only  to  obtain  any  consent  or  approval  for  reopening  said  institu- 
tions from  year  to  year  as  heretofore. 

Restrictive  Ordinances 

In  July,  1911,  the  City  Trustees  of  South  Pasadena,  California, 
passed  an  ordinance  forbidding  the  establishment  within  the 
city  of  any  sanatorium,  asylum  or  retreat  where  consumptives 
are  received  or  treated  under  penalty  of  $300  and  three  months 
in  jail.  The  ordinance  is  typical  of  similar  attempts  to  restrict 
the  establishment  of  hospitals  and  sanatoria  by  local  regulation. 
Whenever  these  ordinances  have  been  tested  in  court,  as  in 
Richmond,  Virginia,  and  Redlands,  California,  they  have  been 
held  to  be  unconstitutional.  The  text  of  a  typical  ordinance 
adopted  in  Redlands,  California,  in  1910,  and  later  declared 
null  and  void  by  the  courts,  is  given  in  full:* 

*  See  page  43. 

32 


Section  I.  Every  hospital,  sanitarium,  pest  house,  asylum  or  other 
place  maintained  or  conducted  for  the  purpose  of  caring  for  or  treating  per- 
sons afflicted  with  any  contagious  or  infectious  disease,  for  or  without  reward 
or  charge,  located  within  four  hundred  (400)  feet  of  the  dwelling  of  another 
person,  or  within  two  thousand  six  hundred  forty  (2640)  feet  of  a  school 
house  or  within  thirteen  hundred  twenty  (1320)  feet  of  a  flowing  stream  of 
water,  water  ditch  or  open  water  conduit  from  which  water  for  domestic  pur- 
poses is  taken,  is  hereby  declared  to  be  a  menace  to  the  public  health  and 
safety,  and  a  public  nuisance,  and  shall  be  abated  by  civil  action  brought 
in  the  proper  court. 

Section  II.  Provides  that  violation  of  the  foregoing  is  a  misdemeanor, 
punishable  by  a  fine  of  not  more  than  $500,  or  imprisonment  in  the  county 
jail  not  exceeding  six  months,  or  by  both  such  fine  and  imprisonment. 


33 


CHAPTER  V 


Some  Opinions  of  Value 

Opposition  to  the  location  of  hospitals  and  sanatoria  at  various 
times  has  called  forth  published  opinions  from  a  number  of  emi- 
nent men  in  different  parts  of  the  country.  The  few  quotations 
chosen  have  been  selected  primarily  because  they  accurately  sum 
up  the  situation.  Letters  from  five  of  the  largest  life  insurance 
companies  in  the  country  expressing  their  attitude  on  the  ques- 
tion of  the  danger  of  infection  spreading  from  a  hospital,  and  the 
opinions  of  health  officers  who  have  been  asked  to  decide  ques- 
tions of  location  of  sanatoria  are  also  included  in  this  chapter. 

Dr.  E.  L.  Trudeau 

The  selection  of  a  site  for  the  Onondaga  County  (N.  Y.) 
Tuberculosis  Hospital  raised  opposition  which  was  overcome 
with  difficulty.  In  connection  with  this  controversy  the 
Syracuse,  N.  Y.,  Journal,  on  March  1,  1913,  published  a  letter 
from  Dr.  Edward  L.  Trudeau,  the  pioneer  of  the  open  air  treat- 
ment of  tuberculosis  in  America,  and  the  founder  of  the  first 
tuberculosis  sanatorium  in  America,  in  which  he  said  in  part : 

"  When  I  bought  the  first  land  on  which  the  Adirondack  Cottage  Sani- 
tarium is  built  (in  1885)  I  paid  $25  an  acre  for  it,  because  it  was  a  small 
piece  and  a  selected  site,  but  the  price  was  then  thought  absurdly  high. 
Every  time  I  have  purchased  more  land  the  price  has  risen  steadily  and  my 
last  purchase  of  five  acres  cost  me  $5,000.  Meanwhile  the  village  of  Saranac 
Lake,  whose  limits  were  nearly  a  mile  away  from  the  sanatorium,  has  steadily 
crept  up  toward  the  institution,  until  now  private  residences  are  built  at  its 
very  gates  and  rent  and  sell  for  prices  which  are  far  in  excess  of  similar  prop- 
erties in  small  ;owns  elsewhere.  Of  course  we  doctors  know  that  the  idea 
of  a  sanatorium's  being  any  danger  to  the  community  in  which  it  is  located 
is  simply  absurd  and  that,  on  the  contrary,  the  education  which  comes  from 
in  its  walls,  is  an  immense  protection  to  the  neighborhood.  Tuberculosis 
is  a  communicable  disease  under  certain  conditions,  but  it  is  not  at  all  like 
any  of  the  highly  infectious  diseases,  such  as  smallpox,  measles,  etc.  It 
is  a  disease  where  any  danger  of  infection  is  within  doors,  and  even  this, 
with  the  simplest  precautions,  can  be  obviated.  To  my  knowledge  there 
has  never  been  an  employee  who  came  to  the  Adirondack  Cottage  Sana- 
torium in  sound  health  who  developed  tuberculosis  while  there;   and  a  sana- 

34 


torium  can  no  more  endanger  the  health  of  the  neighborhood  in  which  it 
is  built,  even  if  the  residences  are  at  its  very  gates,  than  it  could  if  it  were 
placed  on  top  of  a  high  mountain,  miles  away  from  habitation." 

Hamilton  W.  Mabie 

In  reply  to  those  opposing  the  location  of  a  tuberculosis 
hospital  at  Summit,  New  Jersey,  several  years  ago,  Hamilton 
W.  Mabie,  the  well-known  journalist,  wrote  a  long  letter  published 
in  the  Summit  Herald,  November  27,  1909,  taking  up  the 
question  from  a  slightly  different  angle.  One  of  the  principal 
objections  to  the  hospital  was  that  it  would  advertise  the  fact 
that  there  is  an  undue  amount  of  tuberculosis  in  Summit,  and 
would  thus  injure  property.     Quoting  from  his  letter : 

"  Not  only  is  a  sanitarium  for  tubercular  patients  a  distinct  aid  to  the 
healthfulness  of  a  community,  but  it  is  also  a  distinct  addition  to  property 
values.  This  will  probably  strike  many  people  as  an  unwarranted  state- 
ment, but  the  trouble  with  this  matter  is  that  antiquated  ideas  and  unfounded 
impressions  still  prevail  among  those  who  have  not  made  some  study  of  the  sub- 
ject. It  is  a  matter  of  history  that  communities  in  which  sanitariums  are 
established  have  experienced  a  rise  in  values  in  consequence.  If  this  matter 
were  thoroughly  discussed,  I  am  sure  that  both  the  Board  of  Trade  and  the 
town  would  take  a  very  different  attitude  toward  the  possibility  of  introduc- 
ing a  sanitarium  here.  It  would  be  as  logical  to  hold  that  the  Overlook 
Hospital  (a  general  hospital)  is  an  injury  to  the  town  because  it  advertises 
the  fact  that  there  are  accidents  and  sickness  here,  as  to  hold  that  a  sani- 
tarium for  tubercular  patients  would  advertise  the  fact  that  there  is  danger 
of  tubercular  trouble  here.  As  a  matter  of  fact,  the  presence  of  such  a  sani- 
tarium would  advertise  the  extreme  healthfulness  of  this  locality.  That 
has  always  been  the  special  claim  of  Summit  on  people  looking  for  homes, 
and  the  more  widely  the  impression  can  go  abroad  the  greater  will  be  its 
prosperity. 

"  This  question  ought  not  to  be  left  without  a  word  about  its  higher  as- 
pects. Summit  cannot  afford  to  settle  such  a  question  as  this  on  business 
grounds  alone.  There  are  other  things  in  life  besides  real  estate,  and  a  com- 
munity cannot  have  a  better  asset  than  the  reputation  for  large-hearted 
generosity  and  courage.  Everyone  respects  a  community  which,  when  an 
infectious  disease  breaks  out,  does  not  conceal  the  fact,  but  pursues  a  policy 
of  complete  publicity.  Courage  is  always  the  best  policy,  and  so  is  generosity. 
No  one  can  forget  the  contempt  and  indignation  which  was  aroused  by  the 
refusal  of  a  few  settlers  on  Fire  Island  to  allow  women  and  children  who 
had  come  from  Europe  on  a  steamer  in  which  there  was  two  or  three  cases 
of  cholera  to  land  and  take  temporary  shelter,  but  sent  them  back  to  an 
excursion  boat  lying  in  the  open  sea,  with  the  possibility  of  bad  weather." 

Dr.  E.  M.  Mason 

During  1911,  objection  to  the  location  of  the  Red  Mountain 

Tuberculosis  Camp  at  Birmingham,  Ala.,  called  forth  an  open 

letter  from  Dr.  E.  M.  Mason  of  that  city.     Some  of  his  well 

stated  comments  accurately  sum  up  the  situation: 

"  Patients  are  taught  the  nature  of  the  disease  which  they  have  to  combat, 
and  soon  learn  the  precautions  that  must  be  observed  to  prevent  reinfection 
of  themselves  as  well  as  transmission  of  the  disease.     Tuberculosis  cannot 

35 


arise  it  novo,  nor  can  one  contract  it  as  one  would  contract,  for  instance, 
smallpox,  by  mere  proximity  to  a  patient.  One  can  only  acquire  the  tuber- 
culosis germ  from  the  excreta  of  a  patient,  chiefly  sputum.  If  these  be  de- 
stroyed, there  can  be  no  tuberculosis.  It  is  axiomatic  that  if  every  tubercle 
bacillus  could  be  killed  there  would  never  be  another  case  of  consumption. 

"At  the  camp  we  are  enabling  patients  to  throw  off  the  infection  already 
existing  and  are  destroying  all  infected  matter  from  each  patient.  Therefore, 
no  tuberculosis  can  be  disseminated  from  the  camp  nor  from  any  other  prop- 
erly regulated  institution  for  its  treatment.  So  true  is  this,  that  no  well- 
informed  person  would  deny  that  the  citizens  would  be  in  less  danger  of 
contracting  this  disease  if  our  camp  occupied  the  most  central  business  block 
pf  the  city  than  they  are  as  the  conditions  now  exist  in  this  and  every  other 
city.  Every  properly  isolated  case  of  tuberculosis  ceases  to  be  a  menace  to 
the  community,  while  every  recognized,  uncontrolled,  infected  individual 
casts  off  daily  in  his  excreta  millions  of  tuberculous  germs. 

"  Every  broad-minded  humanitarian  movement  in  the  history  of  the 
world  has  been  opposed  by  ignorance  and  prejudice;  the  effect  to  control 
tuberculosis  can  hope  for  no  exemption;  but  our  cause  is  good,  our  work 
is  based  on  a  scientific  study  of  the  disease,  and  the  results  obtained  speak 
:::  the—selves. 


California  Association 

Opposition  to  the  location  of  a  tuberculosis  hospital  in  Men- 
tone,  California,  within  a  certain  distance  of  residences,  a 
school-house,  and  other  buildings,  elicited  the  following  well 
stated  resolutions  from  the  California  Association  for  the  Stud}7 
and  Prevention  of  Tuberculosis: 

"  Resolved,  That  it  is  the  sense  of  the  members  of  the  Executive  Board 
::'  the  California  Association  for  the  Study  and.  Prevention  o:  Tuberculosis, 
that  those  who  attempt  to  prevent  the  establishment  of  properly  conducted 
sanatoria,  are  not  only  in  opposition  to  scientific  facts,  but  that  such  per- 
sons are  sacrificing  human  life  on  the  altar  of  supposed  material  prosperity, 
(although  it  has  been  shown  that  property  values  in  the  neighborhood  of 
crccerly  conducted  sanattria  really  inirease  in  value  :    and  be  it  further 

"  Resolved,  That  this  Executive  Board  deprecates  the  unwise  action 
of  all  such  persons  as  being  unscientific,  inhumanitarian  and  illogical;  and 
that  all  persons  who  will  really  study  this  question  must  come  to  the  con- 
clusion that  the  action  of  such  persons  is  nothing  else  than  an  expression 
of  tuberculo-phobia,  and  to  that  extent  a  menace  to  the  great  movement 
now  in  progress,  which  has  as  its  end,  the  doing  away  with  tuberculosis  as 
a  scourge  to  the  human  race." 

Opinions  of  Life  Insurance  Companies* 

In  March,  1914,  The  National  Association  for  the  Study  and 
Prevention  of  Tuberculosis  addressed  communications  to  five 
of  the  largest  life  insurance  companies  in  the  country,  requesting 
answers  to  the  following  questions: 

1.  Is  residence  or  employment  in  a  tuberculosis  hospital, 
sanatorium    or   dispensary    counted   as    an    adverse   factor   in 

*See  remarks  of  Dr.  Pettit,  page  17. 

36 


considering  the  issuance  of  a  life  insurance  policy  to  a  doctor, 
nurse,  attendant  or  other  employee  of  such  institution,  who 
upon  examination  is  non-tuberculous  ?* 

2.  Is  residence  in  the  neighborhood  of  such  an  institution 
as  above  mentioned  considered  as  an  adverse  factor  in  issuing 
a  policy  to  a  non-tuberculous  applicant  ? 

Two  of  the  companies  answered  the  first  question  in  the  nega- 
tive and  two  in  the  affirmative,  while  one  indicated  an  affirma- 
tive attitude,  though  not  stating  definitely.  The  answers  to 
the  second  question  were  unanimously  in  the  negative. 

It  should  hardly  be  necessary  to  say  that  life  insurance  com- 
panies would  have  most  rigid  and  conservative  ideas  as  to  what 
is  and  what  is  not  an  adverse  factor  in  issuing  a  policy.  Their 
error,  if  any,  would  certainly  be  on  the  side  of  conservatism. 
That  they  do  not  consider  residence  near  a  tuberculosis  sana- 
torium as  an  adverse  factor  must  quiet  the  fears  of  reasonable 
men  and  women  who  have  believed  a  danger  existed  or  might 
exist  from  the  presence  of  such  an  institution.  The  fact  that 
some  companies  look  with  a  degree  of  suspicion  upon  employees 
of  tuberculosis  institutions,  in  the  light  of  so  much  testimony 
supporting  an  opposite  opinion,  indicates  their  extreme  care- 
fulness and  accordingly  gives  additional  support  to  their  con- 
viction that  residence  near  a  tuberculosis  institution  is  not  an 
adverse  factor. 

To  emphasize  this  point,  the  answers  to  the  questions,  giving 
the  name  of  the  company  except  where  it  has  been  requested 
to  withhold  it,  are  given  below: 

From  Arthur  B.   Wright,    M.D.,    Medical   Director  of  The 

Travelers'   Insurance  Company,   Hartford,   Connecticut: 

" This  Company  has  not  modified  in  any  way  the  form  of  policy 

issued  to  a  doctor,  nurse,  attendant  or  other  employee  of  a  tuberculosis 
hospital  or  sanitarium  provided  examination  is  first  class  in  every  other 
respect,  the  assumption  being  that  such  employee  would  be  in  better  posi- 
tion to  follow  out  principles  of  precaution  than  others.  Our  experience  with 
this  class  of  risks  has  been  very  favorable. 

"  In  regard  to  Question  2  would  state  that  we  do  not  consider  as  an  ad- 
verse factor  residence  in  the  neighborhood  of  such  an  institution.  The  same 
principle  would  prevail  as  regards  this  feature,  inasmuch  as  proper  precau- 
tions would  be  followed  by  the  institution  itself." 


*  A  recent  report  by  Dr.  Hamel,  published  in  the  Medico-Statistical  Contributions  of 
the  Imperial  Health  Office  of  Germany,  gives  the  results  of  an  investigation  into  the 
incidence  of  tuberculosis  among  physicians  and  nurses  employed  in  German  sanatoria  and 
hospitals.  Dr.  Hamel's  report,  which  embraces  549  institutions  and  clinics,  2,861 
physicians  and  14,140  nurses  of  all  types,  shows  that  the  rate  of  infection  among  these 
healthy  employees  of  tuberculosis  sanatoria  and  hospitals  is  no  larger  and  is  even  slightly 
less  than  a  similar  rate  recognized  by  insurance  companies  for  New  York  City. 

37 


From  Dr.  Lee  K.  Frankel,  Sixth  Vice-President  of  the  Metro- 
politan Life  Insurance  Company  of  New  York  City: 

" Referring  to  the  two  questions  asked  I  can  answer  these  only 

as  far  as  the  Metropolitan  Life  Insurance  Company  is  concerned. 

"  1.  Residence  or  employment  in  a  tuberculosis  hospital,  etc.,  is  not 
counted  as  an  adverse  factor  in  considering  the  issuance  of  a  life  insurance 
policy  to  a  doctor,  nurse,  etc. 

"2.  Residence  in  the  neighborhood  of  a  sanatorium  is  not  considered 
an  adverse  factor  in  issuing  a  policy  to  a  non- tuberculosis  applicant." 

From  a  high  official  of  a  company  which  does  not  wish  its 
name  used  in  connection  with  this  report : 

"Applicants  for  insurance  who  reside  near  or  are  employed  in  a  tuber- 
culosis hospital,  sanatorium,  or  dispensary,  are  considered  on  their  individual 
merits.  Of  course,  no  applicants  are  accepted  for  insurance  who  on  examina- 
tion are  found  to  be  tuberculous.  The  practice  regarding  the  acceptance  of 
applicants  of  this  class  varies  according  to  local  circumstances.  The  pos- 
sible risk  of  tuberculous  infection  is  carefully  taken  into  account. 

"  The  results  of  the  German  Collective  Sanatoria  Experience  establishing 
for  employees  a  varying  degree  of  liability  to  infection,  are  evidently  sugges- 
tive of  an  extra  risk,  which  it  would  not  be  proper  for  us  to  ignore. 

"  Residence  in  the  neighborhood  of  tuberculosis  hospitals  or  sanatoria  is 
not  considered  an  adverse  factor  in  the  issuing  of  a  policy  to  a  non-tuber- 
culous applicant.  There  is  no  evidence  to  prove  that  the  disease  is  spread 
by  infection  from  a  well  managed  institution  to  the  population  of  the  sur- 
rounding community,  but,  of  course,  there  is  a  certain  degree  of  risk  in  the 
case  of  indiscreet  treatment  of  tuberculous  patients  in  boarding-houses  or 
private  homes,  not  under  proper  medical  supervision  and  control.  All  of 
the  American  life  insurance  companies  transact  business  without  discrimina- 
tion in  localities  which  for  climatic  or  other  reasons  are  particularly  suitable 
for  the  treatment  of  tuberculosis  patients,  and  as  far  as  known,  they  have 
not  experienced  an  appreciably  higher  mortality  from  tuberculosis  among 
their  policyholders  living  in  such  localities  when  compared  with  those  living 
elsewhere." 

From  F.  C.  Wells,  Senior  Medical  Director  of  The  Equitable 

Life  Assurance  Society  of  the  United  States,  New  York  City: 

" I  beg  to  say  that,  first — we  look  with  much  suspicion  and  dis- 
favor upon  any  doctor,  nurse,  attendant  or  other  employee  who  is  spending 
his  time  in  a  tubercular  hospital.  Second,  we  cannot  see  how  residents  in 
the  neighborhood  of  such  an  institution  as  a  tuberculosis  hospital  would  be 
an  adverse  factor  in  issuing  policies  to  non-tubercular  applicants,  provided 
they  do  not  come  in  contact  with  the  disease  in  any  form." 

From  the  Medical  Director  of  a  company  which  does  not 
wish  its  name  used  in  connection  with  this  report: 

"1.  Residence  or  employment  in  a  tuberculosis  hospital,  sanatorium  or 
dispensary  would  be  regarded  as  an  adverse  factor  in  considering  the  issuance 
of  a  life  insurance  policy  to  an  applicant. 

"  2.  Residence  in  the  neighborhood  of  such  an  institution  would  not  be 
regarded  as  an  adverse  factor." 

San  Francisco  Health  Board 

In  1909,  the  San  Francisco  Board  of  Health  expressed  a  favor- 
able  decision   on   the   question  of   permitting  the  local   anti- 

38 


tuberculosis  society  to  operate  a  dispensary  in  a  two-story 
building  especially  constructed  for  the  purpose,  located  in  a 
fairly  prosperous  and  thickly  settled  residential  section  of  that 
city.  The  following  extract  of  an  account  of  the  decision  is 
taken  from  the  "  San  Francisco  Call,"  September  8,  1909: 

"  That  a  tuberculosis  dispensary  in  a  densely  populated  district  is  not  a 
menace  to  public  health  was  the  verdict  of  the  sanitation  and  legislation 
committee  of  the  health  board  yesterday,  this  decision  being  the  direct  out- 
come of  the  controversy  between  the  Jackson  Street  Association  and  the 
San  Francisco  Association  for  the  Study  and  Prevention  of  Tuberculosis. 

The  property  owners  maintained  that  a  dispensary  of  that  character 

was  a  public  menace,  while  the  others  held  that  far  from  being  a  danger 
to  public  health,  it  would  be  a  public  benefit." 


New  York  State  Health  Department 

A  summary  of  the  decisions  rendered  by  the  New  York  State 
Department  of  Health  under  the  law  of  1909  (see  page  31)  shows 
that  in  the  first  three  years,  1909-1911,  twenty-seven  cases 
were  decided.  Of  this  number  eighteen  applications  were  grant- 
ed, six  were  withdrawn  before  decision  was  rendered,  and  only 
six  were  denied. 

Two  of  the  applications  denied  were  for  locations  at  Liberty, 
New  York,  and  one  at  Narrowsburg  in  the  same  region.  Some 
years  ago  the  village  of  Liberty  was  a  summer  resort,  but  like 
many  another  interior  resort,  it  had  to  yield  its  popularity  to 
the  seashore  and  the  mountain  playgrounds  with  special  attrac- 
tions, which  have  been  made  accessible  to  the  public  in  recent 
years  by  railroads.  The  village  apparently  owes  its  present 
prosperity  to  the  fact  that  it  has  become  within  the  last  ten  years 
a  well-known  refuge  for  consumptives.  Some  of  the  inhabitants 
of  Liberty  fail  or  refuse  to  face  the  very  apparent  facts  of  the 
case  and  continue  to  oppose  the  influx  of  consumptives. 

The  application  of  Brith  Abraham,  a  Jewish  insurance  order, 
in  1910,  was  denied  on  the  grounds  that  the  village  and  town  of 
Liberty  were  already  bearing  their  share  of  the  burden  of  caring 
for  tuberculosis  cases  and  that  the  time  had  come  when  those 
desiring  to  erect  sanatoria  should  be  pointed  in  another  direc- 
ton.  The  application  of  Dr.  Horace  Greeley  to  establish  a 
sanatorium  at  Liberty  at  a  later  date  was  denied  on  the  same 
grounds,  with  the  exception  that  Brith  Abraham  asked  for 
permission  to  erect  a  sanatorium  on  unimproved  property, 
while  Greeley  asked  for  permission  to  establish  a  sanatorium 

39 


in  a  well  adapted  farmhouse  on  improved  property    of    sixty- 
acres  just  outside  of  the  village. 

At  the  Greeley  hearing  it  developed  that  if  he  (Greeley) 
wished  to  conduct  a  boarding  house  for  tuberculosis  cases  or 
other  persons  or  both,  he  might  do  so  without  asking  permission 
from  the  local  or  state  authorities.  He  might  use  sanitary 
precautions  or  he  might  not,  provided  he  did  not  wish  to  conduct 
a  "  sanatorium "  for  tuberculosis  cases.  The  residents  of 
Liberty  who  opposed  the  location  seemed  indifferent  as  to  whether 
the  applicant  conducted  a  boarding  house,  but  they  did  object) 
to  a  sanatorium  on  the  grounds  that  it  would  give  Liberty  am 
undesirable  reputation  as  a  resort  for  consumptives,  because 
of  the  advertising  that  would  be  used.* 

*  Copies  of  the  opinion  of  Commissioner  Porter  in  the  Greeley  case  are  on  file  in  the 
office  of  the  National  Association. 


40 


CHAPTER  VI 


Court  Decisions 

Where  the  location  of  hospitals  has  been  so  bitterly  opposed, 
it  is  natural  that  in  a  number  of  instances  recourse  should  have 
been  had  to  the  courts.  Some  of  their  decisions  rendered  in 
cases  of  this  character  are  particularly  pertinent. 

Boston,  Mass. 

The  courts  of  Massachusetts  were  among  the  first  to  give 
recognition  to  the  status  of  a  tuberculosis  sanatorium  in  a  given 
community.  In  1893,  the  Supreme  Court  of  Massachusetts, 
in  the  case  of  the  Free  Hospital  for  Consumptives  of  Boston, 
decided  that  this  institution  was  not  a  menace  either  to  property 
or  to  health  The  decision  which  was  based  upon  the  testimony 
of  the  best  experts  that  could  be  secured,  has  since  been  sus- 
tained by  the  benefit  which  the  institution  has  been  both  to 
the  health  and  property  of  the  community. 

Asheville,  N.  C. 

In  January,  1909,  the  Sisters  of  Mercy  of  Asheville,  N.  C, 
were  temporarily  enjoined  by  the  courts  from  operating  a 
sanatorium  for  tuberculosis  sufferers.  Later,  the  injunction 
was  removed  and  the  Sisters  were  permitted  to  operate  their 
sanatorium. 

Orange,  N.  J. 

In  1909,  a  temporary  injunction  was  issued  against  continuing 
the  tuberculosis  camp  at  Orange,  N.  J.,  but  motion  for  a  perma- 
nent injunction  was  later  denied.  The  camp  consisted  of  a 
remodelled  barn  located  on  the  rear  of  the  property  of  the 
Orange  Memorial  Hospital  and  near  to  the  abutting  property 

41 


of  residents  whose  homes  faced  on  the  street  back  of  the  hospital. 
The  residents  maintained  that  the  camp  was  a  nuisance  and 
menaced  both  their  property  values  and  their  health. 

Vice- Chancellor  Howell's  opinion  on  the  case  (Brikholz  vs. 
Lindsley),  is  contained  in  a  letter  to  the  defendant's  lawyer, 
A.  F.  Skinner,  Newark,  N.  J.,  which  is  printed  in  full:* 

"  In  the  case  of  the  tuberculosis  camp  in  Orange,  I  have  come  to  the  con- 
clusion that  an  injunction  should  not  issue,  and  I  give  you  very  shortly  my 
reasons  for  denying  the  motion,  and  will  ask  you  to  send  a  copy  of  this  letter 
to  Mr.  Lord. 

"  Hospitals  and  pest  houses  are  not  nuisances  per  se.  Their  character  as 
nuisance  depends  upon  their  manner  of  operation,  and  that  operation,  in  order 
to  be  liable  to  the  injunction  process  of  the  court,  must  be  of  such  character 
as  to  damage  the  complainant,  not  generally,  but  with  respect  to  the  use  of 
his  property.  There  are  many  things,  which  a  person  does  not  like  to  have 
planted  next  door  to  his  residence,  but  which  are  entirely  beyond  the  reach 
of  the  law  of  nuisances.  The  Camp,  so-called,  seems  to  be  conducted  with 
great  care  and  propriety.  The  answering  affidavits  are  very  full,  and  while 
they  show  a  situation  which  is  unpleasant  and  which  no  one  would  like  to 
have  next  door  to  him,  yet,  I  think  that  the  affidavits  show  that  the  business 
is  so  carefully  carried  on  and  the  rights  of  the  adjacent  property  owners  so 
well  observed  that  it  is  impossible  for  me  to  say  that  the  complainants  are 
suffering  any  special  damage  over  and  beyond  that  is  suffered  by  every  mem- 
ber of  the  community. 

"  There  is  another  argument,  which  comes  to  mind  from  the  character  of 
the  neighborhood;  if  the  camp  should  be  enjoined,  there  still  remains  in  the 
same  neighborhood,  the  tuberculosis  ward  of  the  Orange  Memorial  Hospital. 
It  is  true,  that  the  hospital  patients  do  not  enter  and  leave  the  premises 
from  the  street,  on  which  the  complainants  live,  but  it  is  there  and  the  in- 
junction in  this  case  would  not  remove  any  objection  to  the  operation  of  a 
hospital. 

"  I  have  come  to  this  conclusion  without  any  reference  to  the  statutes, 
which  were  cited,  because  I  do  not  see  anything  in  either  of  these  three  acts 
can  result  in  giving  the  complainants,  as  private  suitors,  any  new  or  additional 
right  or  cause  of  action.  It  may  be  that  these  statutes  would  be  available  to 
the  public  in  a  public  prosecution,  but  I  fail  to  see  how  the  complainants 
can  derive  any  benefit  from  them  in  this  private  action. 

"As  I  look  at  the  complainants'  case,  it  is  and  must  be  directed  to  show 
facts,  which  will  convince  the  court  that  the  camp  is  being  conducted  in  such 
a  way  as  to  make  a  nuisance.  This  is  the  question  of  fact,  which  ought  to 
be  investigated  on  the  final  hearing. 

"  I  will  advise  an  order  denying  the  motion." 


Richmond,  Va. 

In  an  effort  to  prevent  Dr.  William  Parker,  of  Richmond, 
Va.,  from  operating  the  Chimbarazo  Sanatorium,  the  city 
council  passed  an  ordinance  requiring  a  license  from  the  Board 
of  Health  to  operate  such  an  institution  within  the  city  limits. 
The  courts  declared  the  ordinance  null  and  void  on  the  grounds 
that  the  council  had  no  power  to  enact  it. 


*  Copies  of  the  petition  and  other  papers  in  the  case  are  on  file  in  the  office  of  the 
National  Association. 

42 


Seattle,  Wash. 

In  the  case  of  Everett  vs.  Paschall,  (61  Wash.  47)  the 
Supreme  Court  of  the  State  of  Washington  in  1910  issued  a 
permanent  injunction  restraining  Paschall  from  operating  a 
private  tuberculosis  sanatorium  in  the  residential  section  of 
Seattle.  The  sanatorium  which  accommodated  about  ten 
patients,  was  located  directly  across  an  alleyway  from  the 
property  of  the  plaintiff.  The  lower  court  denied  an  injunc- 
tion but  the  supreme  court  reversed  the  decision  on  the 
grounds  that  the  sanatorium  constituted  a  nuisance.  The  de- 
cision apparently  applies  only  to  hospitals  in  residential  sec- 
tions.    Following  is  a  digest  of  the  court's  opinion: 

Defendant  maintained  a  private  sanatorium  for  the  treatment  of  persons 
afflicted  with  tuberculosis,  and  plaintiff  prays  for  an  injunction.  The  lower 
court  found  as  follows:  That  the  danger  zone  of  tuberculosis  is  about  three 
feet,  beyond  which  there  is  no  danger  of  infection  or  contagion;  that  defendant 
conducted  his  sanatorium  with  a  due  regard  for  the  safety  of  his  patients  and 
thev  public,  that  it  was  a  great  benefit  to  the  community  for  the  disease  is 
very  prevalent,  one-seventh  of  the  deaths  in  the  United  States  being  caused 
thereby;  that  it  was  not  a  nuisance  per  se;  and  that  plaintiffs  were  not  enti- 
tled to  an  injunction.  The  Supreme  Court  of  Washington  held  that  the 
hospital  is  not  a  nuisance  within  the  definition  of  the  common  law,  for  it 
created  no  physical  inconvenience  whatever;  that  but  a  new  element  in  the 
law  of  nuisance  has  been  developed,  namely,  the  comfortable  enjoyment  of 
one's  property;  that  under  this  law  the  maintenance  of  the  sanatorium  is  a 
nuisance.  In  reaching  this  conclusion,  the  court  says  that,  in  determining 
what  is  a  nuisance,  regard  should  be  had  for  the  notions  of  comfort  and  con- 
venience entertained  by  persons  generally  of  ordinary  tastes  and  suscepti- 
bilities. The  discomfort  must  affect  the  ordinary  comfort  of  human  exis- 
tence as  understood  by  the  American  people  in  their  present  state  of  en- 
lightenment. The  neighbors  have  dreaded  and  fear  contagion.  Such  fear 
detracted  from  the  comfortable  use  of  their  property,  so  an  injunction  is 
allowed. 

Redlands,  Cal. 

In  1910,  an  effort  was  made  to  prevent  Dr.  G.  F.  Moseley 
from  operating  the  Mentone  Sanatorium  at  Redlands,  Cali- 
fornia. The  buildings  had  previously  been  used  for  a  sanatorium 
but  the  people  objected  to  their  being  used  again  for  the  purpose. 
In  order  to  restrain  Moseley,  the  Board  of  Supervisors  of  San 
Bernardino  County,  in  July,  1910,  passed  an  ordinance  with  a 
fine  and  imprisonment  penalty  attached,  declaring  tuberculosis 
hospitals  located  in  residential  districts  a  menace  and  a  public 
nuisance  and  prohibiting  their  location. 

As  a  test  case,  Dr.  Moseley  was  put  in  jail  and  applied  for  a 
writ  of  habeas  corpus.  On  December  21,  1910,  Judge  Frank 
F.  Oster  rendered  a  decision*  in  favor  of  the  defendant  on  the 

*  Copies  of  this  decision  are  on  file  in  the  office  of  the  National  Association. 

43 


grounds  that  the  Board  of  Supervisors  exceeded  their  authority 
in  passing  the  restrictive  ordinance.  The  question  of  whether 
the  hospital  was  a  menace  was  not  decided  or  considered  by 
the  court.     The  decision  on  this  point  reads: 

"  Now,  while  there  has  been  much  evidence  introduced  here  on  the  theory 
of  a  public  nuisance,  we  have  no  concern  in  that  matter  on  this  hearing.  It 
is  simply  a  question  of  whether  the  board  of  supervisors  have  the  constitu- 
tional legislative  power  to  enact  this  particular  ordinance,  and  inasmuch  as 
they  have  sought  to  make  that  a  public  nuisance  which,  by  their  own  specifi- 
cations, constitutes  only  a  private  nuisance,  it  seems  to  me  their  authority  | 
is  absolutely  null  and  that  they  have  no  such  power,  and  that  the  ordinance 
is,  therefore,  unreasonable.  It  follows  that  the  defendant  must  be  discharged 
from  custody." 

Houston,  Tex. 

A  more  recent  and  far  more  pertinent  and  explicit  decision 
was  rendered  in  August,  1913,  in  connection  with  the  attempt 
of  the  Anti-Tuberculosis  League  of  Houston,  Texas,  to  locate 
a  tuberculosis  dispensary  in  that  city.  Permission  was  gained 
from  the  county  authorities  to  erect  a  special  building  for  the 
purposes  on  the  grounds  of  the  county  jail  in  the  business  dis- 
trict of  the  city.  Property  owners  and  some  physicians,  in- 
cluding the  local  health  officer,  protested  against  the  site  and  the 
case  was  taken  into  court.  After  an  extended  hearing,  in  which 
evidence  of  every  possible  nature  bearing  on  the  case  was 
admitted,  Justice  Kittrell*  rendered  a  decision  in  favor  of  the 
League,  which  is  of  more  than  ordinary  and  local  significance. 
Part  of  the  opinion  is  quoted  herewith: 

"  In  this  case,  the  evidence  manifestly  preponderates  in  favor  of  the  defend- 
ants. Under  that  point,  there  is  no  reasonable  grounds  for  difference  of! 
opinion. 

"  The  question  involved  is  whether  the  establishment  of  a  clinic  for  the 
treatment  of  persons  afflicted  with  either  incipient  or  clearly  developed^ 
tuberculosis  will  in  all  probability  be  so  harmful  to  property  owners  and  resi- 
dents in  the  section  of  the  city  adjacent  to  the  site  of  the  proposed  clinic,  asi 
to  give  them  the  right  to  injunctive  relief.  The  case  is  one  in  which  the  pref- 
erences and  interests  of  the  few  must  yield  to  the  welfare  of  the  many.  In! 
every  part  of  the  United  States,  warfare  is  being  systematically  and  scien- 
tifically waged  against  tuberculosis,  both  for  the  purpose  of  prevention  and 
cure.  The  results  achieved  in  New  York  show  a  reduction  in  the  number 
of  cases  of  something  like  30  per  cent.,  and  the  increase  of  the  dreadful  disease 
makes  it  necessary  for  the  protection  of  society  that  all  reasonable  means  be 
resorted  to  in  order  to  accomplish  its  extermination  or  at  least  such  mitiga 
tion  of  its  ravages  as  can  be  brought  about  by  advanced  methods  of  treatment. 

"  The  work  must  be  done  somewhere  or  be  stopped  altogether,  and  the 
highest  interests  of  society  demand  that  it  should  not  be  stopped  and  the 
power  of  the  court  should  not  be  put  in  motion  to  arrest  such  work  except 
upon  the  clearest  proof  that  its  prosecution  will  inevitably  result  in  injury 
to  petitioners. 

*  Copies  of  the  opinion  in  this  case  are  on  file  in  the  office  of  the  National  Association. 

44 


"  The  proximity  to  the  county  jail  is  also  urged  as  a  ground  for  relief,  but 
the  hygienic  conditions  of  that  institution  are  far  better  than  are  those  of 
many  homes,  and  the  evidence  is  not  sufficient  to  show  that  such  danger 
exists  as  is  alleged. 

"  The  evidence,  the  far  greater  part  of  which  was  not  only  heard  but  taken 
down  in  writing  with  my  own  hand,  convinces  me  that  a  clinic,  such  as  is 
proposed,  when  conducted  along  the  lines  marked  out,  will  not  imperil  the 
health  of  the  neighborhood,  or  result  in  any  depreciation  of  the  value  of 
property,  and  because  of  the  preponderance  of  the  evidence  is  against  the 
contention  that  it  will,  a  permanent  injunction  is  refused,  and  the  temporary 
injunction  will  be,  and  is,  dissolved." 


45 


CHAPTER  VII 


Summary  and  Conclusions 


Hospital  not  a  Menace  to  Health 

Among  the  many  conclusions  which  may  be  drawn  from  th 
array  of  facts  presented  in  the  preceding  chapters,  none  is  moi 
evident  than  that  a  tuberculosis  hospital  in  itself  is  not  a  menac 
to  the  health  of  those  living  near  it.  This  is  the  most  frequer 
and,  in  practically  all  cases,  the  basic  objection  to  the  locatio 
of  tuberculosis  hospitals  or  sanatoria.  Obviously,  if  there  wei 
no  fear  of  infection,  the  hue  and  cry  frequently  raised  relati\ 
to  the  probable  damage  to  property  through  the  location  of  a 
institution  for  tuberculosis  would  be  largely  dissipated  an 
would  lose  its  force. 

That  such  an  objection,  however,  is  not  a  valid  one,  is  show 
in  the  first  place  by  the  testimony  of  practically  every  supe] 
intendent  who  has  expressed  an  opinion  with  reference  to  tb 
effect  of  his  particular  institution  upon  the  health  of  thos 
living  near  it.  In  not  a  single  case  has  the  National  Associs 
tion  been  able  to  find  evidence  that  would  indicate  the  slightes 
danger  of  infection  from  a  tuberculosis  sanatorium  to  those  wh 
live  on  surrounding  property,  or  who  pass  the  doors  of  th 
institutions  at  frequent  intervals.  The  testimony  of  America 
hospital  superintendents  is  borne  out  furthermore  by  that  ( 
similar  officers  of  European  institutions  who  have  been  aske 
about  this  question.  In  addition,  it  is  greatly  strengthened  b 
proof  submitted  from  many  other  sources,  which  demonstrate 
that  the  infection  of  healthy  employees  through  associatio 
with  patients  within  a  well-regulated  sanatorium  is  almost  ur 
known. 

In  the  second  place,  this  conclusion  is  affirmatively  recognize 
in  opinions  by  various  courts  of  law  and  official  bodies  such  < 
local  and  state  boards  of  health,  that  have  been  asked  to  pa 

46 


upon  the  question  of  the  infectiousness  of  tuberculosis.  The 
unanimous  opinion  expressed  in  practically  every  court  decision 
on  this  point,  is  that  there  can  be  no  danger  of  infection  from 
a  tuberculosis  sanatorium  to  those  who  live  near  it.  Even  the 
courts  that  have  held  adversely  on  the  question  of  the  location 
of  particular  institutions,  have  taken  pains  to  emphasize  the 
lack  of  danger  of  infection  to  the  community. 

Again,  authorities  are  substantially  agreed  in  the  conclusion 
that  this  disease  is  not  transmitted  from  an  institution  to  a 
nearby  dwelling  nor  from  patients  in  passing  a  residence  or 
business  establishment,  nor  from  ordinary  momentary  contact 
with  tuberculous  individuals  in  the  streets  and  business  places 
where  a  tuberculosis  institution  is  located.  Medical  science, 
reinforced  by  pathological  and  bacteriological  research,  is  almost 
unanimous  in  the  opinion  that  infection  from  tuberculosis  can 
be  contracted  only  through  intimate  contact,  directly  with  the 
infectious  discharges  of  a  consumptive,  and  not  through  germs 
that  are  blown  through  the  air  and  inhaled  now  and  then  by 
the  chance  passer-by.  This  experience,  coupled  with  the  well- 
known  and  easily  demonstrable  fact  that  the  rules  of  a  tuber- 
culosis institution  forbid  uncleanliness  and  promiscuous  spitting, 
and  thereby  provide  against  the  carriage  of  germs  from  such 
an  institution  to  neighboring  dwellings,  should  be  conclusive 
proof  of  the  lack  of  danger  to  those  who  are  afraid  to  have  a 
tuberculosis  institution  located  in  their  neighborhood  for  fear  of 
possible  infection. 

Hospital  Not  Detrimental  to  Property 

A  second  conclusion,  which  is  obvious  from  a  study  of  the 
preceding  pages,  is,  that  except  in  rare  instances  a  tuberculosis 
institution  does  not  diminish  the  value  of  surrounding  property. 
It  is  true,  as  Mr.  Baldwin  pointed  out  in  his  study  of  this  sub- 
ject, that  any  building,  no  matter  what  its  use  may  be,  which 
is  not  in  harmony  with  the  other  buildings  of  a  particular  neigh- 
borhood, whether  of  a  residential  or  business  character,  detracts 
from  the  value  of  surrounding  property.  This  would  be  true 
whether  the  building  were  a  church,  a  school,  a  jail,  or  a  hospital. 

On  the  other  hand,  the  answers  to  the  various  questionnaires 
sent  out  in  the  different  studies  which  are  outlined  in  this  pam- 
phlet indicate  that,  for  the  most  part,  a  tuberculosis  hospital 
or  sanatorium  has  little  or  no  effect  upon  the  value  of  property 

47 


immediately  surrounding  it.  In  some  instances  property  values 
have  risen  or  have  decreased,  but  in  the  former  cases  usually 
it  has  been  in  spite  of  the  sanatorium,  and  in  the  latter,  the 
influences  at  work  would  have  diminished  property  values 
whether  the  tuberculosis  institution  were  in  existence  or  not. 
There  are  hardly  any  cases  on  record  where  conclusive  evidence 
is  at  hand  that  a  tuberculosis  hospital  or  sanatorium  has  had 
any  permanent  and  lasting  effect  upon  the  value  of  surrounding 
property.  In  a  few  instances,  which  have  already  been  noted, 
the  sanatorium  has  apparently  had  an  immediate  effect,  but 
this  has  not  lasted.  If  other  influences  in  the  general  neigh- 
borhood have  tended  to  raise  property  values,  the  lots  and 
farms  in  the  vicinity  of  the  sanatorium  have  risen  in  price 
along  with  those  farther  removed. 

This  conclusion  is  affirmed  by  a  careful  study  of  the  property 
values  around  the  five  institutions  which  were  studied  in  care- 
ful detail.  Even  in  the  neighborhoods  where  local  opposition 
had  originally  been  strong  and  in  districts  where  to  some  extent 
opposition  is  at  present  manifest  in  a  few  quarters,  no  evidence 
could  be  found  that  the  tuberculosis  sanatorium  as  such  had 
any  serious  effect  upon  the  value  of  surrounding  property.  In 
the  case  of  Seton  Hospital,  or  the  Sprain  Ridge  Sanatorium, 
where  the  population  is  growing  rapidly  around  the  institutions, 
the  hospitals  have  had  no  apparent  effect  upon  land  values,  even 
though  some  effort  has  been  made  on  the  part  of  certain  prop- 
erty owners  to  utilize  the  institution  as  a  means  for  decreasing 
their  assessments.  A  study  of  the  tables  appended  to  this 
report  will  further  demonstrate  this  fact. 

Initial  Opposition  Seldom  Lasts 

There  are  few  cases  on  record  where  the  initial  opposition, 
which  would  have  prevented  the  location  of  a  given  institution, 
lasted  more  than  a  year  after  the  institution  was  opened.  As 
soon  as  the  neighbors  of  a  tuberculosis  sanatorium  realize  its 
true  character  and  see  that  it  does  not  have  the  harmful  effects 
which  they  had  believed  it  would,  the  opposition  generally 
dies  out.  With  the  disappearance  of  the  opposition,  the  land 
usually  continues  to  increase  or  decrease  in  value  according  to 
its  normal  tendency.  There  can  be  no  stronger  evidence  as  to 
the  foolishness  of  the  opposition  of  those  who  object  to  the 
location  of  tuberculosis  sanatoria  than  this  fact,   that  not   a 

48 


single  instance  can  be  found  where  continuous  organized  oppo- 
sition has  existed  for  more  than  two  years  after  the  establish- 
ment of  a  sanatorium,  although  in  scores  of  instances  such 
organized  opposition  prior  to  the  establishment  of  the  institu- 
tion was  apparently  strongly  intrenched. 

Some  Minor  Objections  to  Sanatoria  Refuted 

In  addition  to  these  main  arguments  advanced  by  those 
who  object  to  the  location  of  sanatoria  in  their  neighborhood 
there  are  a  number  of  objections  of  a  minor  character  which 
should  be  mentioned. 

It  is  frequently  said  that  the  sight  of  sick  persons  wandering 
about  a  neighborhood  is  disquieting  and  depressing.  In  a  few 
instances,  where  sanatoria  or  hospitals  have  been  located  un- 
fortunately near  public  highways,  this  objection  has  some  weight. 
Where  it  is  proposed,  however,  to  establish  a  modern  institu- 
tion, under  modern  conditions,  and  with  modern  methods  of 
supervision,  this  objection  can  have  little  or  no  value.  Tuber- 
culous patients  in  sanatoria  and  hospitals  are  not  allowed,  as 
a  common  practice,  to  roam  around  at  will.  The  most  funda- 
mental principle  of  method  in  the  treatment  of  tuberculosis  is 
that  of  a  rigid  regime  where  every  movement  of  the  patient  is 
under  absolute  control  and  supervision.  In  the  regime  of  most 
tuberculosis  hospitals  it  is  an  offense  punishable  by  discharge 
for  a  patient  to  leave  the  grounds  without  special  permission. 
When  patients  are  allowed  to  exercise  sufficiently  so  that  they 
may  walk  beyond  the  limits  of  the  hospital  grounds,  and  where 
they  will  be  seen  by  the  general  public,  they  are  not  usually 
in  such  physical  condition  as  to  present  an  unpleasant  appear- 
ance to  anyone  whom  they  are  liable  to  meet.  Neither  can  it 
be  said  that  they  are  in  such  instances  liable  to  transmit  tuber- 
culosis to  those  with  whom  they  come  in  contact.  If  a  tuber- 
culous patient  is  impressed  with  one  thing  more  than  another 
from  the  very  day  he  enters  a  sanatorium  until  he  leaves  it, 
it  is  the  danger  of  infecting  others  and  the  methods  of  protect- 
ing those  with  whom  he  associates. 

There  are  others  who  raise  the  objection  that  tuberculosis 
sanatorium  buildings  are  not  attractive  and  therefore  are  ob- 
jectionable. This  is  an  objection  which  has  little  or  no  weight 
at  the  present  time.  A  few  years  ago,  when  the  "shack" 
type  of  construction  was  employed  with  too  much  frequency, 

49 


this  might  have  been  said.  The  present  tendency,  however, 
in  tuberculosis  hospital  construction  is  to  provide  buildings 
which  are  not  only  utilitarian  in  purpose,  but  which  are  durable 
and  possess  real  architectural  merit  and  beauty. 

The  objection  has  also  been  raised  that  tuberculous  patients 
traveling  to  and  from  railroad  stations  or  from  central  points 
of  transportation  are  a  menace  to  those  with  whom  they  come 
in  contact.  There  is  some  division  of  opinion  upon  this  subject. 
It  would  seem  to  be  unwise  in  many  instances  for  a  consider- 
able number  of  tuberculosis  patients  to  travel  in  a  public  con- 
veyance if  some  other  form  of  conveyance  could  be  procured. 
As  a  general  rule,  however,  tuberculous  patients  do  not  travel 
in  public  conveyances  in  any  such  numbers  as  to  create  a  reason- 
able fear  in  the  minds  of  those  with  whom  they  come  in  con- 
tact. In  Boston,  where  an  effort  was  made  at  one  time  to  pre- 
vent the  local  association  from  allowing  tuberculous  patients  to 
travel  on  the  street  cars  to  and  from  the  day  camp,  it  was 
demonstrated  that  the  very  persons  who  had  complained  were 
the  worst  offenders  in  promiscuous  spitting,  and  that  there 
was  practically  no  danger  from  the  tuberculous  patients. 
The  presence  of  an  educated  patient,  who  has  been  to  a  tubercu- 
losis sanatorium,  or  who  is  going  to  one  after  having  submitted 
to  an  examination  for  admission,  is  far  less  dangerous  to  the 
traveling  public  than  the  presence  of  an  ignorant  one  who 
does  not  know  that  he  has  the  disease,  and  who  takes  no 
pains  to  dispose  of  his  sputum  in  a  sanitary  manner.  The 
National  Association  has  still  to  discover  any  case  of  infection 
from  tuberculosis  which  may  be  traced  directly  or  indirectly 
to  contact  with  patients  traveling  to  or  from  a  tuberculosis 
sanatorium  in  a  public  conveyance. 
Hospitals  a  Benefit  to  the  Community 

The  testimony  of  tuberculosis  sanatorium  superintendents 
confirmed  by  first-hand  investigation  and  opinions  of  others 
who  are  in  a  position  to  know,  suggests  that  in  many  cases  a 
tuberculosis  institution  is  a  real  benefit  to  the  community  in 
which  it  is  located.  This  is  a  question  upon  which  it  is  difficult 
to  secure  accurate  and  reliable  information.  If,  however,  the 
reports  of  those  who  have  had  experience  along  this  line  may  be 
relied  upon,  it  would  indicate  that  in  more  than  one-half  of  the 
cases,  tuberculosis  institutions  have  directly  helped  those  living 
in  the  neighborhood  in  one  way  or  another. 

50 


A  tuberculosis  sanatorium  has  frequently  proved  a  blessing, 
possibly  in  disguise,  by  educating  almost  unconsciously  the 
people  living  near  it  to  live  and  sleep  out  of  doors.  The  testi- 
mony of  superintendents  and  others  to  the  effect  that  the  build- 
ing of  a  tuberculosis  sanatorium  has  created  a  demand  for 
sleeping  porches  and  other  forms  of  outdoor  appliances,  is  what 
one  might  expect  from  the  presence  of  such  an  institution. 
Naturally,  such  a  practice  has  a  marked  benefit  upon  the 
health  of  those  who  employ  it.  Statistics  are  lacking  to  demon- 
strate conclusively  the  relative  value  of  a  tuberculosis  sana- 
torium upon  the  death  rate  of  the  persons  living  in  and  around 
it.  The  experience,  however,  of  such  health  centers  as  Rut- 
land, Mass.,  Asheville,  N.  C,  Saranac  Lake,  N.  Y.,  and  else- 
where, would  indicate  that  the  death  rate  of  longtime  residents 
is  apparently  lower  since  the  coming  of  institutions  for  tuber- 
culosis than  previous  to  their  presence.  This  experience  is 
shown  by  the  much  more  careful  statistics  of  various  German 
and  English  sanatoria. 

A  second  benefit  which  a  tuberculosis  sanatorium  often  brings 
to  the  community  is,  that  it  provides  a  market  for  the  supplies 
of  farmers  and  tradesmen  and  for  the  labor  of  the  men  and 
women  in  the  neighborhood.  The  testimony  of  a  score  of  super- 
intendents, confirmed  by  the  published  annual  reports  of  their 
institutions,  demonstrates  the  validity  of  this  conclusion.  A 
tuberculosis  sanatorium,  whether  it  be  a  private  institution  for 
patients  of  means,  or  a  public  institution  with  a  large  pay  roll 
and  a  considerable  number  of  patients,  brings  money  into  the 
community  in  which  it  is  located,  and  thus  adds  not  a  little 
to  the  material  prosperity  of  the  district.  The  expenditure  of 
sums  ranging  from  $20,000  to  $150,000  a  year  in  a  given  town 
or  city,  must  have  a  beneficial  effect  upon  the  business  life  of 
that  community. 

Some  General  Suggestions  as  to  Location 

It  is  difficult  in  a  report  of  this  character  to  offer  suggestions 
with  regard  to  the  location  of  a  sanatorium  or  hospital  that 
will  fit  all  sorts  of  conditions,  since  it  is  obviously  necessary 
that  some  institutions  be  located  in  urban  districts,  while  others 
may  just  as  well  be  located  in  rural  neighborhoods.  Further- 
more, in  many  instances,  considerations  other  than  those  which 
would  relate  merely  to   the  possible  opposition  of  neighbors 

51 


would  require  the  location  of  a  sanatorium  in  one  place  as 
opposed  to  another. 

In  general,  however,  it  is  obvious  that  the  location  of  a  tuber- 
culosis sanatorium  in  a  rural  rather  than  an  urban  district  is 
preferable.  The  majority  of  institutions  in  this  country  are  so 
located.  The  very  fact  that  it  is  desirable  to  have  plenty  of 
room,  unrestricted  light,  and  ventilation  in  and  around  a  tuber- 
culosis institution  makes  a  site  of  this  character  almost  a 
necessity. 

'  It  is  desirable  that  a  tuberculosis  institution  should  not 
be  located  too  near  a  public  highway  or  road.  Satisfactory 
landscape  gardening,  or  the  location  of  the  institution  at 
a  distance  from  the  road  will  prevent  much  unpleasantness 
and  opposition.  A  site  which  affords  advantages  of  this  char- 
acter should  be  sought  for.  Nearly  every  strong  objection  to 
a  tuberculosis  institution  recorded  in  the  preceding  pages  was 
entered  by  a  resident  immediately  across  the  road  from  an 
institution  which  was  unfortunately  situated  too  near  to  the 
highway.  An  inconspicuous  and  tastefully  arranged  institu- 
tion, even  in  a  suburban  district,  will  not  cause  opposition, 
while  the  same  grade  of  institution,  considered  merely  from 
the  clinical  point  of  view,  if  located  in  a  conspicuous  place  and 
surrounded  by  residences,  might  meet  with  violent  opposition. 

Wherever  possible  an  institution  for  tuberculous  patients 
should  provide  its  own  conveyance  to  and  from  the  nearest 
railroad  station.  Many  institutions  have  made  this  mistake 
and  have  located  in  places  where  it  has  been  necessary  to  trans- 
port patients  in  conveyances  along  with  the  residents  of  the 
district.  While  the  danger  from  such  a  course  as  this  can  be 
minimized  and  may  not  exist  at  all,  it  is  sure  to  cause  friction 
if  the  practice  continues,  and  it  is  decidedly  better  to  avoid 
this  possible  opposition  by  providing  an  ambulance  or  some 
other  attractive  vehicle. 

In  the  location  of  a  given  sanatorium,  hospital,  dispensary, 
open  air  school,  or  other  tuberculosis  institution,  three  factors 
should  determine  finally  the  selection  of  a  site.     These  are: 

(1)  The  suitability  of  the  land  for  the  buildings  which  it  is 
proposed  to  erect,  considered  merely  from  the  point  of  view  of 
physical  advantages,  grouping,  attractive  surroundings,  and 
future  economic  administration. 

52 


(2)  The  attitude  of  those  who  live  and  own  property  in  the 
neighborhood  of  the  suggested  site. 

(3)  The  accessibility  of  the  proposed  institution  to  the  cen- 
ters of  population  considered  from  the  point  of  view  (a)  of  the 
future  patients,  their  friends  and  relatives;  (b)  the  physicians 
and  anti-tuberculosis  organizations  who  must  co-operate  with 
it;    and  (c)  the  economical  purchase  and  delivery  of  supplies. 

In  conclusion  it  should  be  borne  in  mind  that  tuberculosis 
hospitals  may  be  located  in  such  a  manner  that  the  opposition 
which  exists  prior  to  their  establishment  will  pass  away  after 
they  have  been  established.  It  is  not  well,  to  countenance 
unreasonable  fear  and  prejudice.  Neither,  on  the  other  hand, 
is  it  wise  to  run  counter  entirely  to  the  expressed  wishes  and 
feelings  of  those  who  live  in  the  neighborhood  of  the  proposed 
institution.  There  is  a  happy  medium  and  a  real  propriety 
which  will  show  those  who  wish  to  establish  tuberculosis  insti- 
tutions how  they  may  turn  these  energies  of  fear  and  prejudice 
to  the  support  of  their  own  work. 


53 


APPENDIX 

TABLES  SHOWING  CHANGE  IN  ASSESSED   VALUA- 
TION OF  SURROUNDING  PROPERTY  OF 
FIVE  HOSPITALS 

The  figures  of  the  following  tables  are  for  land  alone,  with 
the  exception  of  those  for  Hospital  No.  Ill,  which  include 
buildings.  Some  of  the  tables  are  not  complete  because  the 
figures  were  not  available. 

Hospital  No.  I  (Seton  Hospital,  New  York  City)* 

The  numbers  indicate  city  blocks  of  irregular  shape  and 
of  greatly  varying  size.  The  plots  of  Table  1  are  separated 
from  the  hospital  grounds  only  by  the  width  of  the  street  and 
are  considered  adjoining  property.  The  hospital  grounds 
themselves  comprise  an  entire  city  block. 

TABLE  1 

Assessed  Valuation  of  Adjoining  Property,  Showing  Price 
by  Plots 


Plot  No. 

1900 

1905 

1910 

1913 

1914 

Hospital 

1 

$  80,000 

17,700 

14,050 

16,090 

9,500 

2,200 

13,000 

7,100 

17,500 

$110,000 
30,000 
24,800 
28,200 
18,000 
5,500 
23,000 
14,000 
38,000 

$175,500 
48,000 
73,900 
91,400 
27,900 
8,500 
34,400 
20,000 
68,300 

$385,000 

86,800 

145,700 

157,000 

33,000 

7,000 

39,600 

32,800 

87,000 

$383,000 
86,800 

2 

145,700 

3 

157,000 

4 

33,000 

5 

7,000 

6 

29,600 

7 

32,800 

8 

83,900 

*See  Map  facing  page  27. 


54 


TABLE  2 
Property  One  Block  Removed 


Plot  No. 

1900 

1905 

1910 

1913 

1914 

I 

$  10,600 

21,080 

13,505 

10,000 

6,500 

6,500 

7,800 

4,250 

8,500 

10,300 

15,950 

18,850 

6,300 

$  20,000 
31,400 
28,300 
22,000 
12,000 
12,000 
11,200 
7,200 
14,000 
17,700 
27,100 
42,700 
21,500 

$  32,200 
54,300 
52,400 
30,800 
16,500 
15,800 
17,700 
8,800 
25,700 
28,200 
38,200 
45,150 
26,800 

$  53,300 
101,800 
76,700 
51,300 
33,000 
31,600 
29,600 
15,700 
46,500 
49,000 
61,600 
82,100 
47,700 

$  53,300 

II 

98,600 

Ill 

73,900 

IV 

51,300 

V 

33,000 

VI 

31,600 

VII 

29,600 

VIII 

15,700 

IX 

46,500 

X 

49,000 

XI 

62,200 

XII 

82,100 

XIII 

47,700 

TABLE  3 
Property  Two  Blocks  Removed 


Plot 

1900 

1905 

1910 

1913 

1914 

A 

$  23,500 

15,905 

18,700 

13,000 

18,000 

6,000 

5,500 

7,000 

4,100 

6,160 

9,050 

9,900 

4,000 

4,000 

7,000 

7,500 

14,700 

4,400 

40,250 

$  40,000 

33,900 

35,000 

18,000 

30,000 

9,000 

8,000 

11,000 

6,300 

12,300 

19,500 

19,300 

8,000 

7,000 

14,000 

12,460 

22,800 

6,500 

61,800 

$  70,000 
53,500 
59,600 
47,200 
66,500 
14,000 
12,200 
20,100 

9,100 
24,110 
33,900 
28,800 
13,500 
13,500 
19,300 
16,500 
30,800 

9,700 
124,800 

$109,700 

108,500 

103,000 

114,700 

138,900 

25,000 

21,800 

33,700 

14,500 

30,300 

51,500 

40,600 

27,000 

25,000 

39,500 

32,000 

56,200 

22,000 

183,600 

$108,000 

B 

96,700 

C 

88,000 

D 

111,300 

E 

141,500 

F 

25,000 

G 

21,800 

H 

32,800 

I 

14,500 

J 

30,300 

K 

51,500 

L 

40,200 

M 

27,000 

N 

25,000 

O 

39,500 

P 

32,000 

Q 

56,200 

R 

22,000 

AA 

131,100 

55 


Hospital  No.  II  (Sprain  Ridge  Hospital,  Yonkers,  N.  Y.) 

TABLE  1 

Assessed  Valuation  of  Adjoining  Property,  Showing  Prices 
per  Acre 


Plot  No. 

1906 

1969 

1912 

1914 

Hospital 

1 ; 

$  450 

380 

200 

200 

1,000 

630 

1,000 

1,275 

1,310 

$  450 

380 

200 

200 

500 

815 

1,000 

1,220 

1,190 

$  450 
400 
300 
300 
500 
815 
1,000 

$  450 
500 

2 

300 

3j 

300 

4 

1,000 

5 

1,185 

6 

1,000 

7 

8 

1,963 
1,686 

TABLE  2 
Nearby  Property 


Plot  No. 

1906 

1909 

1912 

1914 

9 

$  550 

425 

500 

1,500 

1,125 

1,150 

650 

1,000 

$  550 

425 

500 

1,500 

1,525 

1,600 

650 

1,000 

$  550 

425 

500 

2,000 

1,525 

1,600 

650 

1,000 

$  1,000 
425 

10 

11 

1,000 

12 

2,000 

13 

1,525 

14 

15 

1,600 
1,150 

16 

1,175 

Hospital  No.  Ill   (Bowne  Memorial  Hospital,  Poughkeepsie, 

N.  Y.) 

TABLE  1 

Showing  Assessed  Valuation  of  Adjoining  Property  per 
Plot,  with  Acreage  of  Plots 


Plot  No. 

Acreage 

1908 

1909 

1910 

1912 

1 

2 

3 

4 

7A 
80 

59 

12 

4 

(21 

\60 

$1,000 
6,000 

3,600 
1,600 
1,500 
2,500 
3,500 

$1,000 
6,000 

3,600 
1,600 
1,800 
2,500 
3,500 

$6,600 

3,860 
1,760 
2,000 
2,750 
3,850 

$1,200 

6,600 

/  55  acres  \ 

\      2,500  / 

1,760 

5 

2,000 

6 

2,8001 
3,800/ 

56 


TABLE  2 
Nearby  Property 


Plot  No. 

Acreage 

1908 

1909 

1910 

1912 

7 

30 
10 

20 
/22 

119 

$     800 

500 
3,500 
2,200 
5,000 

$     800 

/374  acres) 

\    20,000  / 

11,000 

4,500 

500 

4,000 

2,200 

5,000 

$     800 

/200  acres) 

\    15,000  / 

12,100 

4,950 

550 

4,400 

2,420 

6,600 

$     900 

/100  acres) 

\      5,000  J 

12,100 

5,000 

550 

8 

9 

10 

11 

12 

4,000 
2,400 
6,600 

13 

Hospital  No.  IV  (Montefiore  Home  Country  Sanatorium,  Bed- 
ford Hills,  N.  Y.)* 

TABLE  1 

Assessed  Valuation  of  Adjoining  Property,  Showing  Price  per 

Plot,  with  Acreage  of  Plots 


Plot 

Acreage 

No. 

1 

83 

2 

75 

3 

4 

122 

5 

60 

6 

130 

7 

75 

8 

21 

9 

71 

10 

68 

10. .... 

12 

80 

11 

185 

1903 


1906 


1908 


1911 


1913 


$7,000 

6,450 
6,000 
3,500 


15,000 
189  acres) 
12,250  / 


$15,000 


12,500 


3,500 


10,000 
25,000 


$15,000 

7,000 

85  acres 

4,700 

12,000 

7,000 

10,500 


3,500 
20,000 
151  acres 
11,000 
10,000 
25,000 


$15,000 
7,000 

85  acres 
4,700 
12,000 
7,000 
9,000 
5,000 

'  3,500 
25,000 
/151  acres 
\    15,000 


35,000 


$15,000 

7,000 

85  acres 

7,000 

12,000 

7,500 

10,000 

7,000 

5,000 

3,500 

35,000 

/151  acres\ 

20,000  / 

16,000 

50,000 


TABLE  2 
Nearby  Property 


Plot 

Acreage 

1903 

1906 

1908 

1911 

1913 

No. 

I 

40 

$  2,400 

$  2,400 

$  4,000 

$  7,500 
/  73  acres  \ 
X    22,000  / 

III 

150 

$12,000 

20,000 

30,000 

IV 

120 

15,000 

15,000 

15,000 

15,000 

V 

76 

12,000 

25,000 

30,000 

30,000 

II 

34 

7,500 

6,500 

10,000 

7,000 

*See  map  facing  page  26. 


57 


Hospital    No.    V    (Gaylord    Farm    Sanatorium,    Wallingford, 

Conn.) 

TABLE  1 

Showing  Assessed  Valuation  of  Adjoining  Property  per 
Plot,  with  Acreage  of  Plots 


Plot  No. 

Acreage 

1903 

1905 

1910 

1913 

l : 

34 
70 
12 

44 

92 
123 

70 
38 

$     640 

460 

1,800 
1,050 

$    600 
840 

525 

1,800 
1,800 

1,190 
494 

$     811 

2,200 

204 

972 
(84§  acres\ 
\      2,320  / 

4,200 
/108  acres) 
\      1,920  / 

865 

$    810 

2 

2,200 
204 

3, 

4 

/  30  acres  \ 
\        600   I 

5 

/84|  acres\ 
{     1,555  / 

4,200 
/108  acres\ 
I      1,920  / 
865 

6 

7 

8 

TABLE  2 
Nearby  Property 


Plot  No. 

Acreage 

1903 

1905 

1910 

1913 

9 

68 
62 

$    800 
1,035 

$    800 
1,035 

$1,765 
1,797 

$1,7-65 

10 

1,800 

DATE  DUE 


MlMjm 


*m? 


900 


' 


'.-■•• 


^Jp.-jim-^iSSMpM.- 


:m 


DEMCO  38-296 


COLUMBIA  UNIVERSITY  LIBRARIES 


0049981501 


